Abstract Details

Title Standardizing care of leptomeningeal carcinomatosis (LMC): Impact on survival and the role for advanced practitioners in developing Ommaya clinics

Topic Neuro-oncology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-012

Objective n/a

Background Leptomeningeal carcinomatosis (LMC) is a complication of primary cancers and occurs when there is invasion of the leptomeninges/CSF by neoplastic cells which can cause neurological dysfunction and abnormal imaging. Incidence of LMC is increasing as cancer patients are living longer, some on immuno-oncotherapies and others due to limited CNS penetration of cancer therapies. Patients present with classic neurological signs and symptoms and treatment is grounded in radiation, systemic therapies and medical management. However, there remains no standard of care for these patients and they are commonly excluded from clinical trials. Most agree that local CNS control coupled with systemic therapy offers the best survival. Here we propose the value of establishing Ommaya clinics (OC) with standard approaches to treatment for all LMC cases within the institution. With use of advanced practitioners (APs), physician time in procedural clinics is decreased and patient care continuity is increased.

Design/Methods A single institutional evaluation of 157 patients (2012-2019) was reviewed. 69 of 157 were excluded, leaving 48 pre-OC and 40 OC patients.

Results The mOS (weeks) of those treated with intrathecal chemotherapy (ITC) versus no ITC was compared between cohorts: pre-OC and OC (3.36 vs 15.6). The mOS was compared between breast (5 vs 28), lung (3 vs 9.7) and melanoma (5 vs 10) patients in the pre-OC and OC respectively. The standardized treatment regimen developed for patients in the OC includes whole-brain radiation, Ommaya reservoir placement, systemic treatment coupled with ITC (2x weekly – q other month) and MR imaging every 3 months.

Conclusions Patients treated according to the standardized regimen experienced longer overall survival with breast cancer patients faring best followed by melanoma and lung patients. The use of APs has demonstrated value through standardized care and protocol development which translates to increased overall survival, improved neurological function and clinical surveillance of LMC patients.

Authors/Disclosures
Erika Leese, PA (Geisinger Medical Center) PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
Na Tosha N. Gatson, MD, PhD, F�鶹��ýӳ��	Dr. Gatson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GT Medical Technologies. Dr. Gatson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Menarini Silicon Biosystems. Dr. Gatson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NuvOx Pharmaceuticals. Dr. Gatson has received publishing royalties from a publication relating to health care. Dr. Gatson has a non-compensated relationship as a Board Member with Society for Equity in Neurosciences (SEQUINS) that is relevant to �鶹��ýӳ�� interests or activities.

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