دورية أكاديمية
Intrathecal topotecan with systemic checkpoint inhibitor therapy for gastroesophageal cancer with leptomeningeal involvement: two case reports and review of the literature.
| العنوان: | Intrathecal topotecan with systemic checkpoint inhibitor therapy for gastroesophageal cancer with leptomeningeal involvement: two case reports and review of the literature. |
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| المؤلفون: | Pabon CM; Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Yeboa DN; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., O'Brien BJ; Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Majd NK; Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Wang C; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Blum Murphy MA; Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. |
| المصدر: | Journal of gastrointestinal oncology [J Gastrointest Oncol] 2024 Jun 30; Vol. 15 (3), pp. 1331-1340. Date of Electronic Publication: 2024 Jun 20. |
| نوع المنشور: | Case Reports; Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: AME Publishing Group Country of Publication: China NLM ID: 101557751 Publication Model: Print-Electronic Cited Medium: Print ISSN: 2078-6891 (Print) Linking ISSN: 20786891 NLM ISO Abbreviation: J Gastrointest Oncol Subsets: PubMed not MEDLINE |
| أسماء مطبوعة: | Publication: Hong Kong : AME Publishing Group Original Publication: Hong Kong : Pioneer Bioscience Pub. Co. |
| مستخلص: | Background: Leptomeningeal metastases (LM) in gastroesophageal (GE) malignancies are exceedingly rare. Historically, treatment for LM has included steroids, radiation, chemotherapy, and intrathecal (IT) chemotherapy. However, the outcomes in GE malignancies with LM remain poor. Unfortunately, clinical trials in GE malignancies have traditionally excluded those with LM, limiting advances in therapeutic strategies. Given that LM poses potentially devastating neurologic and psychologic sequelae, there is an urgent need for more effective treatments. Case Description: Patient 1 is a 44-year-old woman with localized esophageal adenocarcinoma who undergoes neoadjuvant chemoradiation followed by esophagectomy. Seven months following surgery, she develops ataxia, weakness, and nausea/vomiting. Magnetic resonance imaging (MRI) reveals intracranial disease that is subsequently successfully resected and then treated with gamma knife (GK) radiation. Pathology confirms metastases. Three months later she is found to have LM. She receives palliative whole brain radiation therapy as well as focal radiation to the spine. Following this she transitioned to concurrent IT topotecan plus intravenous (IV) ipilumumab/nivolumab with durable response beyond 14 months. Patient 2 is a 71-year-old man with de novo metastatic esophageal adenocarcinoma with durable response to 5-fluorouracil plus irinotecan. Asymptomatic intracranial metastases are detected on surveillance scans 2 years after initial diagnosis for which he receives GK. Follow up MRI identifies new LM. As such, to treat the LM, he was transitioned to IT topotecan and IV pembrolizumab with good response for 6 months until death from a gastrointestinal bleed. Conclusions: We present two cases of LM in patients with GE adenocarcinoma who had longer survival than what has been reported. They were treated with combination IT topotecan and IV checkpoint inhibition. Further studies evaluating the central nervous system tumor immune-microenvironment can help expand our understanding of how this combination has worked well in our patients and how to care for others with similar scenarios. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jgo.amegroups.com/article/view/10.21037/jgo-24-70/coif). B.J.O.B. reports that she participates on a data safety monitoring board for Plus Therapeutics. Mariela Murphy reports that she participates in the advisory board for Astrazeneca. The other authors have no conflicts of interest to declare. (2024 Journal of Gastrointestinal Oncology. All rights reserved.) |
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| فهرسة مساهمة: | Keywords: Esophageal adenocarcinoma; case report; intrathecal chemotherapy with concurrent systemic immunotherapy; leptomeningeal metastases (LM) |
| تواريخ الأحداث: | Date Created: 20240711 Latest Revision: 20240712 |
| رمز التحديث: | 20240712 |
| مُعرف محوري في PubMed: | PMC11231862 |
| DOI: | 10.21037/jgo-24-70 |
| PMID: | 38989402 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 2078-6891 |
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| DOI: | 10.21037/jgo-24-70 |