for those with leptomeningeal metastases
 

a large series with 103 patients with l-m metastasis was just published. It unfortuantely mainly covers intrathecal chemo choices rather than IT herceptin, is not particularly uplifting but may be informative(regarding IT chemo choices) I hope

J Neurooncol. 2013 Mar 1. [Epub ahead of print]
A retrospective case series of 103 consecutive patients with leptomeningeal metastasis and breast cancer.
Le Rhun E, Taillibert S, Zairi F, Kotecki N, Devos P, Mailliez A, Servent V, Vanlemmens L, Vennin P, Boulanger T, Baranzelli MC, André C, Marliot G, Cazin JL, Dubois F, Assaker R, Bonneterre J, Chamberlain MC.
Source
Department of Medical Oncology, Oscar Lambret Center, 3 rue Frédéric Combemale, 59020, Lille Cedex, France, emilie.lerhun@chru-lille.fr.
Abstract
Approximately 2-5 % of patients with breast cancer (BC) develop leptomeningeal metastasis (LM). 103 consecutive patients with BC were diagnosed with LM and initially treated with intra-CSF liposomal cytarabine from 2007 to 2011 at a single institution. Correlations were determined with respect to patient characteristics and BC subtype with regard to overall survival (OS). At LM diagnosis, 61 % of patients had a 0-2 performance status (PS), the remaining 39 % were severely neurologically impaired. Regardless of PS, all patients received intra-cerebrospinal fluid (CSF) liposomal cytarabine as first-line treatment. Systemic treatment and radiotherapy were also given in 58 and 17 % of patients respectively as clinically appropriate. Second- (intra-CSF thiotepa) and third-line (intra-CSF methotrexate) treatment was administered in 24 and 6 patients respectively. Median OS was 3.8 months (range 1 day-2.8 years). In multivariate analysis, an initial combined treatment, a second-line treatment with intra-CSF thiotepa, an initial clinical response, and a non-'ER/PR/HER2 negative' BC were significantly associated with a better OS. Median OS in this heterogeneous retrospective case series was similar to that of previously observed BC patients treated with intra-CSF methotrexate suggesting intra-CSF liposomal cytarabine is a reasonable first choice therapy of BC-related LM.
PMID: 23456656