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Cui et al. Diagnosis and treatment of meningeal carcinomatosis

treatment of MC. Therefore, intrathecal trastuzumab in combination with the cytological CSF analysis.
is the only targeted therapy for MC in patients with In addition, the technology of high-throughput
HER2-positive breast cancer. sequencing of CSF which recognizes cancer-
related DNA will provide significant reference for
Rituximab, an anti-CD20 monoclonal antibody, shows the diagnosis in clinics. Traditional treatments
efficacy in patients with diffuse large-B-cell lymphoma, including surgery, RT, systemic chemotherapy and
its effects in MC are limited because of its large intrathecal chemotherapy, but the prognosis for
molecular size leading clinicians to study intrathecal MC remains very poor with a median survival of <
rituximab. [116-118] A case-series analysis of relapsed 3 months. Recently, molecular targeting treatment
CNS lymphoma demonstrated that intraventricular and immunotherapy have been applied to MC and
administration of rituximab showed efficacy in six have shown breakthrough results. The prognosis of
cases. Intraventricular rituximab was administered in MC may be affected by several factors such as age,
dose of 10-40 mg, produced a total elimination rate performance status, primary tumor histology. Age of
of malignant cells in CSF for three patients and a more than 50, low Karnofsky performance status,
disappearance of leptomeningeal lymphoma nodules lung cancer or malignant melanoma as primary tumor
in one patient. [118] Therefore, these results show the may be the negative prognostic factors in cases with
potential of intrathecal rituximab for patients of MC with MC. Therefore, precise diagnostic techniques remain
CD20-positive lymphoma. to be investigated, and novel therapeutic targets need
to be found to improve the life quality and prolong the
Vemurafenib, a BRAF inhibitors, possesses a good survival time for the patients with MC.
perspective in late stage of melanoma patients with
BRAF mutatation. In a case report, vemurafenib DECLARATIONS
showed clinical and imaging responses and
improvement of survival time. [119] Authors’ contributions
Study concept and design: J.Y. He
Immunotherapy Manuscript drafting: J.Z. Cui
CpG-28, a Toll-like receptor 9 (TLR-9) agonist, can Manuscript revising: Q. Li
boost both the innate and the adaptive immune system Data collection: X.Q. Li, R.P. Gao, H. Bu
through stimulation of TLR-9 and have antineoplastic Literature search: Y.L. Zou, X.S. Guo, W.X. Han, Z.Y.
activity in animal models. [120] In a phase I trial, 29 Zhao, Y.Y. Li, M.M. Zheng, Y.J. Liu, L.T. Yan
patients with MC received injection of CpG-28 both
subcutaneously and intrathecally, which indicated Financial support and sponsorship
the tolerance and feasibility of intrathecal injection None.
with CpG-ODN for cases with MC. [121] The median
PFS was 7 weeks and OS was 15 weeks. This new Conflicts of interest
immunostimulating agent was also used in patients with There are no conflicts of interest.
recurrent glioblastoma, which showed good security
and some cases of mild reactions. [122,123] Based on the Patient consent
current study results from each phase of clinical trials, There is no patient data involved.
immunotherapy has become a new direction of clinical
researches on MC. Ethics approval
Not applicable.
CONCLUSION
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174 Neuroimmunology and Neuroinflammation ¦ Volume 4 ¦ September 18, 2017