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Pellerino et al. J Cancer Metastasis Treat 2020;6:41 Journal of Cancer
DOI: 10.20517/2394-4722.2020.80 Metastasis and Treatment

Review Open Access

Leptomeningeal metastases from non-small cell
lung cancer: state of the art and recent advances

Alessia Pellerino , Valeria Internò , Erminia Muscolino , Francesca Mo , Francesco Bruno , Edoardo
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Pronello , Federica Franchino , Riccardo Soffietti , Roberta Rudà 1
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1 Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin 10126, Italy.
2 Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari 70121, Italy.
Correspondence to: Dr. Alessia Pellerino, Department of Neuro-Oncology, University and City of Health and Science Hospital,
via Cherasco 15, Turin 10126, Italy. E-mail: alessia.pellerino@unito.it
How to cite this article: Pellerino A, Internò V, Muscolino E, Mo F, Bruno F, Pronello E, Franchino F, Soffietti R, Rudà R.
Leptomeningeal metastases from non-small cell lung cancer: state of the art and recent advances. J Cancer Metastasis Treat
2020;6:41. http://dx.doi.org/10.20517/2394-4722.2020.80
Received: 11 Aug 2020 First Decision: 15 Sep 2020 Revised: 30 Sep 2020 Accepted: 14 Oct 2020 Published: 29 Oct 2020
Academic Editor: Lombardi Giuseppe Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Patients with leptomeningeal metastases (LM) from non-small cell lung cancer (NSCLC) have a poor outcome
with survival of less than 1 year regardless of advancements in treatment strategy. In the past, some randomized
clinical trials have been conducted with heterogeneous inclusion criteria, diagnostic parameters, response
evaluation and primary endpoints. Efforts to develop a standardized magnetic resonance imaging (MRI)
assessment and liquid biopsy techniques to monitor disease evolution in plasma or cerebrospinal fluid (CSF) are
underway. This review aims to cover the main clinical and diagnostic challenges of LM from NSCLC, in particular
the role of MRI, CSF cytology and liquid biopsy for the diagnosis and monitoring of the disease, as well as the most
recent clinical trials on targeted therapies. Targeted therapy, such as epidermal growth factor receptor tyrosine
kinase inhibitors and anaplastic lymphoma kinase rearranged inhibitors, represent a feasible treatment with
encouraging results in terms of disease control and survival. For ineligible patients, immune checkpoint inhibitors
could represent a therapeutic option with acceptable tolerance, although clinical trials focused on LM from NSCLC
are lacking and represent a research focus for the future.

Keywords: Anaplastic lymphoma kinase inhibitors, epidermal growth factor receptor tyrosine kinase inhibitors,
clinical trials, immunotherapy, leptomeningeal metastases, liquid biopsy

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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