Treatment of Leptomeningeal Carcinomatosis in EGFR-Mutated Non-Small-Cell Lung Cancer

Leptomeningeal metastasis in the setting of EGFR-mutated non-small-cell lung cancer (NSCLC) represents a distinct and demanding clinical scenario. This protocol defines the recommended management approach for this specific sub-population.

Clinical scenario

The patient has EGFR-mutated NSCLC with confirmed leptomeningeal metastasis (LM). The EGFR mutation status shapes both eligibility and the therapeutic strategy used in this setting.

Treatment approach — partial overview

Management of this scenario centres on CNS-penetrant targeted therapy, which has the most available clinical data in EGFR-mutated NSCLC with LM. An intrathecal chemotherapy approach with supportive supplementation has also been investigated in clinical trials. The complete agent selection, criteria, and sequencing are available in the full structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.esmoop.2023.101624

Promising results have been reported in patients with EGFR-mutated NSCLC and LM using osimertinib, the agent with the most available data.
Intrathecal pemetrexed was explored in a phase I/II trial of 30 patients with LM from epidermal growth factor receptor (EGFR)-mutant non-small-cell lung cancer (NSCLC).
In this trial, 50 mg pemetrexed was combined with vitamin B12 and folic acid supplementation.

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