Intrathecal (IT) Herceptin (Trastuzumab) for brain mets (Leptomeningeal Metastases)

[YoungMD]

I apologize, the cytotoxic compliment to IT Herceptin used in Yale is IT thiotepa, 50 mg weekly. It is similar to other combination therapies I've read about in the literature, specifically a combination of IT Herceptin and IT methothrexate (100 mg/wk and 25 mg/wk, respectively). The reservation, of course, with a cytotoxic compliment is that it is cytotoxic. Both methothrexate and thiotepa stay around in the meninges and in the body for a long time, and have documented side effects such as arachnoiditis and some neurodegeneration. That being said, they were valuable compliments to IT Herceptin. Using methothrexate or thiotepa in monotherapy stops working after 5-6 months, in some cases longer, simply because you are attacking the tumor with just one agent, rather than a targeted agent and a cytotoxic agent. Other cytotoxic agents that I've encountered in literature was etoposide 1 mg/wk, topotecan, as was mentioned earlier in this thread, and Xeloda as a systemic compliment that has some CNS penetration.

CBD oil is cannabidol oil (hemp oil). While I am cautious about people making outlandish claims that it is a panacea for neoplasms of all kind, real research suggests that brain and breast origin tumors have endocannabinoid receptors that could be targets for at least few of the many cannabidols found in hemp oil. Plus, anecdotal and formal evidence suggests it potentiates response to pain meds, potentially allowing patients to take less pain meds with the same effect. Generally, these compounds also have an anti-inflammatory effect. If it doesn't have THC, it is not psychoactive and in my book, doesn't hurt. The dosage I've seen is 25 mg/day, which in some blends translates to 2 ml of oil a day.