What is the best course of action for a patient with isolated carcinomatous meningitis who is responding well to intrathecal methotrexate but now has MRI findings suspicious for methotrexate leukoencephalopathy?

Can intrathecal methotrexate be continued with close neurologic observation vs switch in treatment now due to findings?

Answer from: at Academic Institution

Neurological toxicities of intrathecal methotrexate tend to be categorized by the timeline of onset after treatment. Acute MTX toxicity includes arachnoiditis, encephalitis, transverse myelopathy, and seizures. This tends to be readily reversible including neuroimaging findings. Subacute MTX toxicit...

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Medical Oncologist at Kaiser Permanente Medical Group
Thank you so much. Very helpful.

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What is the best course of action for a patient with isolated carcinomatous meningitis who is responding well to intrathecal methotrexate but now has MRI findings suspicious for methotrexate leukoencephalopathy?

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