Treatment for leptomeningeal metastases

There are no set guidelines for treating leptomeningeal metastases because doctors are still looking at which treatments work best at entering the cerebrospinal fluid (CSF), how well they work at treating the cancer 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.

The treatment you have 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 idea 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: 

  • injected into a vein (intravenous) 
  • injected into the spinal fluid (by lumbar puncture Open a glossary item or ventricular access device called Ommaya reservoir)

Ventricular access devices allow you to have chemotherapy straight into the fluid filled spaces of the brain (ventricles). So it goes straight into the cerebrospinal fluid (CSF).   

Diagram showing butterfly accessing Ventricular device

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.

Vemurafenib and dabrafenib are two types of targeted cancer drugs which have helped some people with certain types of melanoma skin cancer and non small cell lung cancer (NSCLC) with leptomeningeal metastases.

Bevacizumab (Avastin) can sometimes help people with lung cancer that have leptomeningeal metastases.

Gefitinib, erlotinib, afatinib or osimertinib are other types of targeted cancer drugs that doctors might use to treat leptomeningeal metastases in certain types of non small cell lung cancer (NSCLC).

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, including leptomeningeal metastases. This includes different:

  • 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.

Last reviewed: 
22 Nov 2019
Next review due: 
22 Nov 2022
  • EANO – ESMO Leptomeningeal Metastasis Clinical practice Guidelines
    E LE Ehun and others
    Annals of Oncology, 2017. Volume 28, Supplement 4, pages iv84 – iv99

  • How we treat patients with leptomeningeal metastases
    E L Rhun and others
    ESMO Open, 2019

  • New Strategies in the management of leptomeningeal disease
    M D groves
    Arch Neurol, 2010. Volume  67, Issue 3, Pages 305 - 312

  • Leptomeningeal Metastases: Current Concepts and Management Guidelines
    S Chowdary and M Chamberlain
    Journal of the National Comprehensive Cancer Network, 2005. Volume3, Issue 3, Pages 693 – 703

  • Management of Leptomeningeal Metastases in Non-Oncogene Addicted Non-Small Cell Lung Cancer
    A Turkaj and others
    Frontiers in Oncology, 2018. Volume 8, pages 1 – 9

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact with details of the particular issue you are interested in if you need additional references for this information.

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