Title:A Review on the Efficacy and Safety of Intrathecal Administration of
Novel Medications for Leptomeningeal Metastases in Solid Cancers
Volume: 31
Issue: 19
Author(s): Fatemeh Jafari, Mohammad Moeini Nodeh, Hesamoddin Hosseinjani, Hamed Baharara, Sajad Azad, Omid Arasteh*, Thomas P. Johnston and Amirhossein Sahebkar*
Affiliation:
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad,
Iran
- Biotechnology Research Center,
Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied
Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department
of Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
Keywords:
Leptomeningeal disease, leptomeningeal carcinomatosis, solid tumors, intrathecal, LMD, malignancy.
Abstract: Leptomeningeal disease (LMD) is a rare and lethal manifestation that may occur
in the advanced stages of solid tumors and hematological malignancies. With advances
in diagnostic techniques, the detection and confirmation of the presence of LMD
have increased. Although its optimal treatment remains a challenge, the use of the intrathecal
route for the delivery of novel therapeutics is now considered a promising drug
delivery strategy to complement radiation and systemic-based therapies. Although
methotrexate, cytarabine, and thiotepa have a long history in the treatment of LMD, other
medications have also been shown to be beneficial. In this article, we have reviewed the
effects of novel medications administered via the intrathecal route for the treatment of
solid tumors. We have searched PubMed, Scopus, and Google Scholar databases till the
end of September 2021 using the following keywords: “leptomeningeal disease”, “leptomeningeal
carcinomatosis”, “leptomeningeal metastases”, “solid tumors”, “solid cancers”,
and “intrathecal”. Our literature findings have uncovered that most studies on
LMD, which occurs secondary to solid cancers, are available as ‘case reports’, and few
clinical trials have been conducted to date. Single-drug (monotherapy) or combination
drug therapy, administered via the intrathecal route, especially in metastatic breast and
lung cancer, has been shown to improve patients' symptoms and overall lifespan, while
exhibiting a low and acceptable prevalence of side effects. However, judgments/conclusions
about the effectiveness and safety of these drugs still require further clinical evaluation.
