A review on intrathecal administration of medications for leptomeningeal metastases in solid tumors
Leptomeningeal disease (LMD) is a particular mode of central metastasis in malignant tumors. It occurs when tumor cells infiltrate the subarachnoid space and cerebrospinal fluid (CSF), spreading throughout the central nervous system (CNS). LMD is a rare but devastating complication of malignant tumo...
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Frontiers Media S.A.
2025-02-01
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| Series: | Frontiers in Pharmacology |
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| author | Xuemei Wang Chi Yao Li Quan Junxiang Zhou |
| author_facet | Xuemei Wang Chi Yao Li Quan Junxiang Zhou |
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| description | Leptomeningeal disease (LMD) is a particular mode of central metastasis in malignant tumors. It occurs when tumor cells infiltrate the subarachnoid space and cerebrospinal fluid (CSF), spreading throughout the central nervous system (CNS). LMD is a rare but devastating complication of malignant tumors. It can occur in various types of cancers, with lung and breast cancer being the most frequently associated. The treatment approach for LMD includes a combination of supportive care, surgery, chemotherapy, radiotherapy, targeted therapy, immunotherapy, and intrathecal (IT) therapy, among other modalities. Despite the challenges in determining the optimal treatment for LMD, IT therapy remains one of the primary therapeutic strategies. This therapy can directly circumvent the blood–brain barrier. Moreover, a low-dose medication can achieve a higher drug concentration in the CSF, resulting in better cytotoxic effects. Chemotherapy drugs such as methotrexate, cytarabine, and thiotepa have been widely studied as traditional IT therapies. In recent years, the advent of novel anti-tumor drugs has led to a growing number of agents being employed for IT administration in the treatment of malignant tumors with LMD. This article presents a comprehensive review of the current advancements in IT administration of chemotherapy, targeted, and immunotherapy drugs for the treatment of LMD in solid tumors. In addition, we also discuss the safety issues associated with IT therapy, summarize the advantages of IT administration of different types of anti-tumor drugs, and put forward some suggestions for reducing adverse reactions. It is hoped that future research will focus on exploring more potentially effective anti-tumor drugs for IT treatment, conducting in-depth pharmacokinetic studies, and developing long-acting and low-toxic IT administration regimens for the treatment of meningeal metastases. |
| format | Article |
| id | doaj-art-36ea987185474faab2432805d664fd07 |
| institution | Kabale University |
| issn | 1663-9812 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pharmacology |
| spelling | doaj-art-36ea987185474faab2432805d664fd072025-02-04T06:32:00ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122025-02-011610.3389/fphar.2025.14729451472945A review on intrathecal administration of medications for leptomeningeal metastases in solid tumorsXuemei Wang0Chi Yao1Li Quan2Junxiang Zhou3Department of Clinical Pharmacy, Shifang People’s Hospital, North Sichuan Medical College, Deyang, ChinaDepartment of Hepatobiliary Surgery, Shifang People’s Hospital, North Sichuan Medical College, Deyang, ChinaDepartment of Clinical Pharmacy, Shifang People’s Hospital, North Sichuan Medical College, Deyang, ChinaDepartment of Pharmacy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Afffliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, ChinaLeptomeningeal disease (LMD) is a particular mode of central metastasis in malignant tumors. It occurs when tumor cells infiltrate the subarachnoid space and cerebrospinal fluid (CSF), spreading throughout the central nervous system (CNS). LMD is a rare but devastating complication of malignant tumors. It can occur in various types of cancers, with lung and breast cancer being the most frequently associated. The treatment approach for LMD includes a combination of supportive care, surgery, chemotherapy, radiotherapy, targeted therapy, immunotherapy, and intrathecal (IT) therapy, among other modalities. Despite the challenges in determining the optimal treatment for LMD, IT therapy remains one of the primary therapeutic strategies. This therapy can directly circumvent the blood–brain barrier. Moreover, a low-dose medication can achieve a higher drug concentration in the CSF, resulting in better cytotoxic effects. Chemotherapy drugs such as methotrexate, cytarabine, and thiotepa have been widely studied as traditional IT therapies. In recent years, the advent of novel anti-tumor drugs has led to a growing number of agents being employed for IT administration in the treatment of malignant tumors with LMD. This article presents a comprehensive review of the current advancements in IT administration of chemotherapy, targeted, and immunotherapy drugs for the treatment of LMD in solid tumors. In addition, we also discuss the safety issues associated with IT therapy, summarize the advantages of IT administration of different types of anti-tumor drugs, and put forward some suggestions for reducing adverse reactions. It is hoped that future research will focus on exploring more potentially effective anti-tumor drugs for IT treatment, conducting in-depth pharmacokinetic studies, and developing long-acting and low-toxic IT administration regimens for the treatment of meningeal metastases.https://www.frontiersin.org/articles/10.3389/fphar.2025.1472945/fullsolid tumorsleptomeningeal diseaseintrathecal therapychemotherapy drugsimmunotherapy drugstargeted drugs |
| spellingShingle | Xuemei Wang Chi Yao Li Quan Junxiang Zhou A review on intrathecal administration of medications for leptomeningeal metastases in solid tumors Frontiers in Pharmacology solid tumors leptomeningeal disease intrathecal therapy chemotherapy drugs immunotherapy drugs targeted drugs |
| title | A review on intrathecal administration of medications for leptomeningeal metastases in solid tumors |
| title_full | A review on intrathecal administration of medications for leptomeningeal metastases in solid tumors |
| title_fullStr | A review on intrathecal administration of medications for leptomeningeal metastases in solid tumors |
| title_full_unstemmed | A review on intrathecal administration of medications for leptomeningeal metastases in solid tumors |
| title_short | A review on intrathecal administration of medications for leptomeningeal metastases in solid tumors |
| title_sort | review on intrathecal administration of medications for leptomeningeal metastases in solid tumors |
| topic | solid tumors leptomeningeal disease intrathecal therapy chemotherapy drugs immunotherapy drugs targeted drugs |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2025.1472945/full |
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