Other nonrandomized studies have been performed [14, 15] investigating the effectiveness and side effects of liposomal cytarabine in Selleck I BET 762 neoplastic meningitis. Overall, a fair tolerability profile has emerged. The frequent occurrence of chemical meningitis may be prevented by concomitant steroid treatment. The main reason for continuing
use of liposomal AraC in these patients—apart from the lack of a consolidated and effective standard of care—is the need Inhibitors,research,lifescience,medical for less frequent lumbar punctures in often severely ill patients. However, the levels of evidence in favour of this approach are weak. A recent determination of EMA has temporarily suggested to consider alternative therapies to liposomal AraC after an inspection to the production site of the drug in California; treating physicians are waiting for a solution of this possibily temporary problem. Other widely Inhibitors,research,lifescience,medical adopted intrathecal treatments apart from liposomal AraC include methotrexate and thiotepa. Preliminary experiences show the feasibility of associating rituximab with liposomal cytarabine in patients with recurrent neoplastic meningitis [16]. Also systemic bevacizumab may be effective in some cases on neoplastic meningitis [17], in combination Inhibitors,research,lifescience,medical with
other systemic chemotherapeutic agents. Some effect has been reported for systemic treatment with systemic gefitinib or erlotinib in NSCLC with neoplastic meningitis, and with sorafenib in renal cancer, whereas the role of trastuzumab in breast cancer with neoplastic meningitis is still debatable Inhibitors,research,lifescience,medical (reviewed in [18]). 4. Prospective Collection of Newly Diagnosed Neoplastic Meningitis Cases from Solid Tumors in Lombardia In 2011 a prospective collection of patients diagnosed with neoplastic meningitis from solid tumors was started in a number of Centers in Lombardia. The aim of this study is to assess the pattern of care in this often
underdiagnosed and undertreated condition. Previous work Inhibitors,research,lifescience,medical from an analogous initiative in Piedmont [19] supports the concept that a higher index of suspect tuclazepam for diagnosis may lead to earlier diagnosis of this condition. Increase in frequency of neoplastic meningitis may indeed be a consequence of survival increase in a number of systemic malignancies thanks to advances in targeted therapies, as well as of more widespread use of MRI in the followup of these patients. In 12 months, 26 patients with neoplastic meningitis from solid extra-CNS tumors have been diagnosed. Their clinical features are reported in Tables Tables11 and and22. Table 1 Demographic features, site of primary tumor and PS. Table 2 Clinical signs and symptoms at onset of neoplastic meningitis. Cerebrospinal fluid analysis was performed in 22 out of 26 patients, yielding the following results: in 18/22 patients, CSF analysis revealed malignant cells.