P14.03 Meninges metastases in breast cancer-one center study experience of concomitant therapy intrathecal and systemic

Breast cancer occupies the central nervous system frequently. The treatment is controversial. Therapeutic recommendations depend on the patient’s condition,suggesting only palliative care, or radiotherapy or intrathecal therapy, the systemic therapy on a trial basis.There are different forms of the meninges infiltration: meningitis with the cancer cells in the cerebrospinal fluid or the solid infiltrates, only as enlargment or classical metastases to the meninges. Currently the base of the diagnose is a result of the MR and the clinical symptoms; positive cerebrospinal fluid analysis is not required. Classical meningitis lasts 4 to 11 weeks, while the solid leasion is a chronic disease and can last for many months. We present one-center study experience of concomitant therapy:intrathecal and systemic in the group of patients, in which the spread to meninges was proven without the classical meningitis symptoms. Material: from 2007 to 2015 27 patients with confirmed spread were treated. Overexpression of HER 2 (9 patients) and triple negative (5 patients coexisted with brain metastases, while the luminal B1/A (13 patients) with the bone mets. Except of one case, it was always a multi-organ disease. METHODS:We used liposomal cytarabine. We plan to give 6 intrathecal injections every 14 days, the systhemic therapy depends on the biological subtype and on the former used drugs. We applied: Liposomal doxorubicine (10 patients), Fulvestrant / Aromataze inhibitor (8 patients),Cisplatine (4 patients),Paclitaksel (3 patients) and Lapatinib with Capecytabine (2 patients). The response to treatment was monitored by clinical evaluation and MR. Results: the period between the original diagnose to meninges recurrence took in average 41,3 months. No relation between the frequency of occurence of the meningitis and the subtype of breast cancer was found. . Time to progression was between 2,9 - 189 months. The median survival time is 5,8 months. The longlasting survival of 189 months concerns a patient with luminal B1 subtype.We used liposomal cytarabine injections 73 times, in average 3 injections.. Reason of all premature withdraw was deterioration of patient’s condition. There was no case of withdrawing due to any advers events. The biggest clinical benefit was observed in case of the patients who were treated with Lapatinib and Capecitabine - OS 11-12 months; and those treated with hormonal therapy -OS 6-10 months. An objective response,monitored by MR was confirmed in the group of patients treated with Lapatinib (2 patients) and of those treated with Cisplatine (4