Treatment for leptomeningeal metastases
Doctors are still looking at which treatments best enter the cerebrospinal fluid (CSF). They also want to know how well they work at treating leptomeningeal metastases and their side effects.
The CSF is a clear fluid that surrounds the brain and spinal cord. The CSF supports and protects the brain and the spinal cord.
The aim of treatment is usually to control the growth of the cancer and relieve symptoms.
Your treatment depends on where the cancer started (the primary cancer), for example, in the breast or lung. Treatments generally include chemotherapy, targeted cancer drugs or radiotherapy.
Below is an overview of some of the treatments you might have depending on the primary cancer:
Chemotherapy uses anti cancer drugs to kill cancer cells. They work throughout your body and are called systemic treatment.
You might have chemotherapy in one or more of the following ways for leptomeningeal metastases:
- injected into a vein (intravenous)
- injected into the spinal fluid. This is done by
lumbar puncture 
or a ventricular access device. The device is called an Ommaya reservoir. Having treatment this way is also called intrathecal chemotherapy
Ventricular access devices allow you to have chemotherapy straight into the fluid filled spaces of the brain. These spaces are called ventricles. So, it goes straight into the cerebrospinal fluid (CSF).
The most commonly used chemotherapy drugs include:
- methotrexate
- cytarabine
- thiotepa
The drug you have depends on your type of primary cancer.
Targeted cancer drugs work by targeting the differences in cancer cells compared to normal cells that help them to survive and grow. Some targeted drugs that are being used to treat leptomeningeal metastases include:
- trastuzumab emtansine in HER2-postive breast cancer
- erlotinib or gefitinib in a type of lung cancer called adenocarcinoma
- ceritinib in non small cell lung cancer (NSCLC)
Talk to your doctor if you want to know more about targeted drugs to treat leptomeningeal metastases for your type of primary cancer.
Radiotherapy is the use of radiation, usually x-rays, to treat cancer cells.
Radiotherapy to the brain can help to reduce symptoms. This is usually radiotherapy to the whole brain, but some people might have targeted radiotherapy to one area of the brain.
Research into leptomeningeal metastases
Researchers continue to look into the best treatment for cancers that have spread. This includes leptomeningeal metastases. Research is looking at:
- combinations of drugs
- newer targeted cancer drugs
- drugs that help the immune system to fight cancer cells (immunotherapy)
Help and support
It can be difficult to cope with leptomeningeal metastases. Your doctor and cancer nurse specialist are your best source of information. You can ask them if there are any cancer support groups in your area or any local groups that offer practical help. It might help to speak to other people in a similar situation to you.
You can also call the Cancer Research UK information nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday.
If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.
It can help to talk to those close to you. Some people decide that they would like to try counselling.
