New hope for leptomeningeal disease care

When cancer spreads to the central nervous system, it usually goes to the brain tissue. In a small but growing number of cases, though, it shows up in the cerebrospinal fluid surrounding the brain and spinal cord and/or in the leptomeninges, the lining of the brain and spinal cord. This type of metastasis is known as leptomeningeal disease (LMD), or leptomeningeal carcinomatosis. Since leptomeningeal disease cancer cells float in the cerebrospinal fluid, they can quickly spread throughout the central nervous system. As a result, leptomeningeal disease has a poor prognosis, with survival typically measured in months. The Neuro-Oncology department at MD Anderson is expanding its LMD program dedicated to better understanding and treating the disease. Barbara O’Brien, M.D., assistant professor of neuro-oncology, recently spoke with us about leptomeningeal disease and our effort to help patients with this condition. What cancer types are most prone to leptomeningeal disease? Leptomeningeal disease tends to occur most commonly with cancers that spread to the central nervous system. This includes breast cancer, lung cancer and melanoma. What are the most common symptoms of leptomeningeal disease? The most common symptoms include an altered mental state, which means confusion, and a pressure headache that is worst in the morning and that gets progressively more intense over several days and weeks. Other symptoms can include seizures, double vision or even a numb chin. What led to the creation of MD Anderson’s leptomeningeal disease program? We desperately need better treatments for our patients. We also need to understand why some patients may be at higher risk of developing leptomeningeal disease. Classically, leptomeningeal disease was considered a very late-stage...