Friday, August 7, 2015

Leptomeningeal disease - a case study

Intrathecal administration of tumor-infiltrating lymphocytes is well tolerated in a patients with leptomeningeal disease from metastatic melanoma:  A case report.  Glitza, Haymaker, Bernatchez, et al.  Cancer Immunol Res. 2015 Jul 27.

Patients with leptomeningeal disease from melanoma have very poor outcomes and few treatment options.  This is a case of intrathecal administration  [an injection directly into the spinal fluid] of autologous tumor infiltrating lymphocytes (TIL) in a patient with leptomeningeal disease (LMD) which developed after prior treatment with surgery, high-dose bolus IL-2, and systemic TIL infusion and experienced radiographic progression after intrathecal (IT) IL2 therapy.  Pt was given weekly treatment with increasing numbers of IT TIL followed by twice weekly IT IL2.  Analysis of CSF demonstrated increased inflammatory cytokines following the treatments.  Subsequent imaging demonstrated stable disease and neurological deficits also remained stable.  The patient expired 5 months after the initiation of IT TIL therapy with disease progression in the brain, liver, lung and abdominal lymph nodes but, WITHOUT LMD progression.  These results demonstrate safety of IT TIL and support a prospective clinical trial to determine clinical benefit in these patients.

Very sad overall.  Though hopeful in the sense that while IL2 intrathecally didn't help...when combined with TIL it did.  This is a very difficult situation that some melanoma patients and their families face, so any treatment improvements will certainly be a boon.  Why this patient wasn't simultaneously or previously administered an immunotherapy is not mentioned.  But, it seems to me that might have been helpful as well.

Wishing you all my best.  - c

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