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Prolonged survival of patients with non-small-cell lung cancer with leptomeningeal carcinomatosis in the modern treatment era.
Clin Lung Cancer. 2014 May; 15(3):202-6.CL

Abstract

INTRODUCTION

Leptomeningeal carcinomatosis (LM) is a severe complication of non-small-cell lung cancer (NSCLC) historically associated with poor prognosis. New chemotherapeutic and targeted treatments could potentially affect the natural history of LM.

PATIENTS AND METHODS

Patients with a pathologic diagnosis of NSCLC with LM treated at Stanford between 2003 and 2011 were identified via institutional databases and medical records. LM was defined by cerebrospinal fluid (CSF) that was positive for malignant cells or by LM enhancement on magnetic resonance imaging with gadolinium contrast. Retrospective, landmark analyses were performed to estimate survival. Statistical analyses were performed using SAS Enterprise Guide, version 4.3.

RESULTS

LM was identified in 30 patients. All cases were adenocarcinoma; 60% of patients had a known or suspected driver mutation. The mean age was 58 years. Of the 30 patients, 67% were women; 70% were nonsmokers; 27% initially presented with LM; 84% received systemic treatment at or after development of LM; and 53% of these patients received modern systemic therapy for their LM, defined as a regimen containing pemetrexed, bevacizumab, or a tyrosine kinase inhibitor. Mean overall survival after LM diagnosis was 6 months (95% CI, 3-12). Patients who received modern systemic therapy for LM had decreased hazard of death (hazard ratio [HR], 0.24; P = .007).

CONCLUSION

In this retrospective, single-institution analysis, median survival with LM was higher compared with historical experience. Patients who received modern systemic therapy for their LM had particularly good outcomes. These data provide evidence for improving survival outcomes in the modern treatment era for this difficult-to-treat complication.

Authors+Show Affiliations

Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA; Department of Internal Medicine, University of California Davis School of Medicine; Division of Hematology/Oncology, University of California Davis Cancer Center, Sacramento, CA. Electronic address: jonathan.riess@ucdmc.ucdavis.edu.Division of Neuro-Oncology, Department of Neurology, Stanford University School of Medicine, Stanford, CA.Department of Radiology, Stanford University School of Medicine, Stanford, CA.Department of Radiology, Stanford University School of Medicine, Stanford, CA.Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA.Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA.Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA.Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

24524822

Citation

Riess, Jonathan W., et al. "Prolonged Survival of Patients With Non-small-cell Lung Cancer With Leptomeningeal Carcinomatosis in the Modern Treatment Era." Clinical Lung Cancer, vol. 15, no. 3, 2014, pp. 202-6.
Riess JW, Nagpal S, Iv M, et al. Prolonged survival of patients with non-small-cell lung cancer with leptomeningeal carcinomatosis in the modern treatment era. Clin Lung Cancer. 2014;15(3):202-6.
Riess, J. W., Nagpal, S., Iv, M., Zeineh, M., Gubens, M. A., Ramchandran, K., Neal, J. W., & Wakelee, H. A. (2014). Prolonged survival of patients with non-small-cell lung cancer with leptomeningeal carcinomatosis in the modern treatment era. Clinical Lung Cancer, 15(3), 202-6. https://doi.org/10.1016/j.cllc.2013.12.009
Riess JW, et al. Prolonged Survival of Patients With Non-small-cell Lung Cancer With Leptomeningeal Carcinomatosis in the Modern Treatment Era. Clin Lung Cancer. 2014;15(3):202-6. PubMed PMID: 24524822.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prolonged survival of patients with non-small-cell lung cancer with leptomeningeal carcinomatosis in the modern treatment era. AU - Riess,Jonathan W, AU - Nagpal,Seema, AU - Iv,Michael, AU - Zeineh,Michael, AU - Gubens,Matthew A, AU - Ramchandran,Kavitha, AU - Neal,Joel W, AU - Wakelee,Heather A, Y1 - 2014/01/01/ PY - 2013/12/02/received PY - 2013/12/28/revised PY - 2013/12/28/accepted PY - 2014/2/15/entrez PY - 2014/2/15/pubmed PY - 2014/12/15/medline KW - CNS disease KW - Chemotherapy KW - Leptomeningeal carcinomatosis KW - NSCLC KW - Targeted therapy SP - 202 EP - 6 JF - Clinical lung cancer JO - Clin Lung Cancer VL - 15 IS - 3 N2 - INTRODUCTION: Leptomeningeal carcinomatosis (LM) is a severe complication of non-small-cell lung cancer (NSCLC) historically associated with poor prognosis. New chemotherapeutic and targeted treatments could potentially affect the natural history of LM. PATIENTS AND METHODS: Patients with a pathologic diagnosis of NSCLC with LM treated at Stanford between 2003 and 2011 were identified via institutional databases and medical records. LM was defined by cerebrospinal fluid (CSF) that was positive for malignant cells or by LM enhancement on magnetic resonance imaging with gadolinium contrast. Retrospective, landmark analyses were performed to estimate survival. Statistical analyses were performed using SAS Enterprise Guide, version 4.3. RESULTS: LM was identified in 30 patients. All cases were adenocarcinoma; 60% of patients had a known or suspected driver mutation. The mean age was 58 years. Of the 30 patients, 67% were women; 70% were nonsmokers; 27% initially presented with LM; 84% received systemic treatment at or after development of LM; and 53% of these patients received modern systemic therapy for their LM, defined as a regimen containing pemetrexed, bevacizumab, or a tyrosine kinase inhibitor. Mean overall survival after LM diagnosis was 6 months (95% CI, 3-12). Patients who received modern systemic therapy for LM had decreased hazard of death (hazard ratio [HR], 0.24; P = .007). CONCLUSION: In this retrospective, single-institution analysis, median survival with LM was higher compared with historical experience. Patients who received modern systemic therapy for their LM had particularly good outcomes. These data provide evidence for improving survival outcomes in the modern treatment era for this difficult-to-treat complication. SN - 1938-0690 UR - https://www.unboundmedicine.com/medline/citation/24524822/Prolonged_survival_of_patients_with_non_small_cell_lung_cancer_with_leptomeningeal_carcinomatosis_in_the_modern_treatment_era_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1525-7304(13)00272-6 DB - PRIME DP - Unbound Medicine ER -