How do you treat leptomeningeal carcinomatosis in metastatic breast cancer?

Do you consider placing an Ommaya for IT chemo with methotrexate or cytarabine? Knowing that leptomeningeal carcinomatosis carries such a poor prognosis, I discuss goals of care and comfort-oriented approaches such as hospice with my continuity patients, but we're asked to see patients for a second opinion regarding chemotherapy options.

Answer from: Medical Oncologist at Academic Institution

LMD is a challenging clinical scenario. I will consider placement of Ommaya and IT MTX or cytarabine in select patients, generally limited systemic disease and good PS. If any evidence of bulky disease, will check CSF flow study prior to placement. Other options include systemic high dose methotrexa...

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Medical Oncologist at Kettering Cancer Center
What about if breast cancer is Her2 neu (+)?

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How do you treat leptomeningeal carcinomatosis in metastatic breast cancer?

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