Abstract
Treatment of meningeal carcinomatosis among breast cancer patients remains a clinical challenge, with a dismal outlook for long-term survival. Intrathecal thiotepa administration has been described in the literature; however, there are practical challenges of administration into the intrathecal space, and there is no significant difference in drug exposure as measured by AUC between intravenous and intrathecal routes. One female with meningeal relapse of HER2-positive breast cancer hospitalized and felt to be preterminal was treated with IV thiotepa in 2010. Her neurologic status returned to baseline within 3 weeks, and she was felt to be in a complete radiologic and clinical remission, which continues to present day. This compelling case suggests a role for IV thiotepa in the treatment of breast cancer patients with meningeal carcinomatosis, and further study is warranted.
