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Intrathecal pemetrexed for leptomeningeal metastases in a patient with ALK-rearranged lung adenocarcinoma : a case report

Gezelius, Emelie LU ; Planck, Maria LU ; Hazem, Bassam LU ; Nagpal, Seema and Wakelee, Heather (2025) In Cancer Chemotherapy and Pharmacology 95(1).
Abstract

Progressive leptomeningeal metastases (LM) are associated with intractable neurological symptoms and a poor prognosis, and effective treatment options are limited. Intrathecal (IT) pemetrexed has been shown to confer clinical benefit in lung adenocarcinoma, yet our understanding of the efficacy and safety of the treatment is limited. We report a patient with a long-standing history of leptomeningeal disease due to ALK-positive adenocarcinoma of the lung, previously controlled by increased doses of lorlatinib (125 mg/day). Rapid LM progression prompted the start of IT pemetrexed, after which the patient experienced immediate clinical improvement. The case provides additional support that IT pemetrexed can offer symptomatic relief and may... (More)

Progressive leptomeningeal metastases (LM) are associated with intractable neurological symptoms and a poor prognosis, and effective treatment options are limited. Intrathecal (IT) pemetrexed has been shown to confer clinical benefit in lung adenocarcinoma, yet our understanding of the efficacy and safety of the treatment is limited. We report a patient with a long-standing history of leptomeningeal disease due to ALK-positive adenocarcinoma of the lung, previously controlled by increased doses of lorlatinib (125 mg/day). Rapid LM progression prompted the start of IT pemetrexed, after which the patient experienced immediate clinical improvement. The case provides additional support that IT pemetrexed can offer symptomatic relief and may be considered as a treatment option in advanced LM. Furthermore, the case illustrates that an increased dose of lorlatinib may efficiently control LM in patients with ALK-rearranged NSCLC, following progression on standard lorlatinib dosage.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
ALK, Case report, Intrathecal pemetrexed, Leptomeningeal metastasis, Non-small cell lung cancer
in
Cancer Chemotherapy and Pharmacology
volume
95
issue
1
article number
6
publisher
Springer Science and Business Media B.V.
external identifiers
  • scopus:85212273264
  • pmid:39688636
ISSN
0344-5704
DOI
10.1007/s00280-024-04735-8
language
English
LU publication?
yes
id
706661ba-c052-4e11-ab4d-152ba51b70a1
date added to LUP
2025-03-03 15:37:04
date last changed
2025-08-19 06:03:21
@article{706661ba-c052-4e11-ab4d-152ba51b70a1,
  abstract     = {{<p>Progressive leptomeningeal metastases (LM) are associated with intractable neurological symptoms and a poor prognosis, and effective treatment options are limited. Intrathecal (IT) pemetrexed has been shown to confer clinical benefit in lung adenocarcinoma, yet our understanding of the efficacy and safety of the treatment is limited. We report a patient with a long-standing history of leptomeningeal disease due to ALK-positive adenocarcinoma of the lung, previously controlled by increased doses of lorlatinib (125 mg/day). Rapid LM progression prompted the start of IT pemetrexed, after which the patient experienced immediate clinical improvement. The case provides additional support that IT pemetrexed can offer symptomatic relief and may be considered as a treatment option in advanced LM. Furthermore, the case illustrates that an increased dose of lorlatinib may efficiently control LM in patients with ALK-rearranged NSCLC, following progression on standard lorlatinib dosage.</p>}},
  author       = {{Gezelius, Emelie and Planck, Maria and Hazem, Bassam and Nagpal, Seema and Wakelee, Heather}},
  issn         = {{0344-5704}},
  keywords     = {{ALK; Case report; Intrathecal pemetrexed; Leptomeningeal metastasis; Non-small cell lung cancer}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{Springer Science and Business Media B.V.}},
  series       = {{Cancer Chemotherapy and Pharmacology}},
  title        = {{Intrathecal pemetrexed for leptomeningeal metastases in a patient with ALK-rearranged lung adenocarcinoma : a case report}},
  url          = {{http://dx.doi.org/10.1007/s00280-024-04735-8}},
  doi          = {{10.1007/s00280-024-04735-8}},
  volume       = {{95}},
  year         = {{2025}},
}