Intrathecal chemotherapy for leptomeningeal metastasis of non-small-cell lung cancer: a systematic review.

BACKGROUND

Leptomeningeal metastasis (LM) is a severe complication of advanced non-small-cell lung cancer (NSCLC) that is increasingly detected due to improved diagnostics. Intrathecal therapy, which involves delivering drugs directly into the subarachnoid space, has become a key treatment approach. A variety of cytotoxic drugs, targeted therapies, immune-checkpoint inhibitors, and combination treatments are now available through different intrathecal protocols, offering new hope to patients.

METHODS

Extensive searches were conducted in PubMed, Embase, the Cochrane Library, Web of Science, Wanfang Data, CNKI, and VIP. Data collected included histological subtype, intrathecal delivery method, treatment regimen, median progression-free survival (mPFS), median overall survival (mOS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs) in ≥10% of patients.

RESULTS

Twelve clinical studies with 544 patients (average age 53.27 years) met the criteria. Drug delivery was via lumbar puncture or Ommaya reservoir. Objective response rates were 34.5%-86.4%, and disease control rates were 62.5%-94.9%. Three trials reported progression-free survival of 3.5, 6.3, and 9.6 months, with overall survival from 3.66 to 17 months. AEs in over 10% of patients included myelosuppression, gastrointestinal issues, and neurological symptoms.

CONCLUSION

Intrathecal therapy offers significant clinical benefits, especially when combined with other treatments, with a manageable toxicity profile.