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REVIEW article

Front. Pharmacol.
Sec. Pharmacology of Anti-Cancer Drugs
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1472945
This article is part of the Research Topic Reviews in Pharmacology of Anti-Cancer Drugs: 2023 View all 7 articles

A Review on Intrathecal Administration of Medications for Leptomeningeal Metastases in Solid Tumors

Provisionally accepted
Xuemei Wang Xuemei Wang 1Chi Yao Chi Yao 1Li Quan Li Quan 1Junxiang Zhou Junxiang Zhou 2*
  • 1 Shi Fang, Deyang, China
  • 2 Sichuan Cancer Hospital, Chengdu, Sichuan Province, China

The final, formatted version of the article will be published soon.

    Leptomeningeal disease (LMD) is a particular mode of central metastasis in malignant tumors. It occurs when tumor cells infiltrate the subarachnoid space and cerebrospinal fluid (CSF), spreading throughout the central nervous system. LMD is a rare but devastating complication of malignant tumors. It can occur in various types of cancers, with lung cancer and breast cancer being the most frequently associated. The treatment approach for LMD includes a combination of supportive care, surgery, chemotherapy, radiotherapy, targeted therapy, immunotherapy, and intrathecal (IT) therapy, among other modalities. Despite the challenges in determining the optimal treatment for LMD, IT therapy remains one of the primary therapeutic strategies. This therapy can directly circumvent the influence of the blood brain barrier. Moreover, a low dose medication can achieve a higher drug concentration in the CSF, resulting in better cytotoxic effects. Chemotherapy drugs such as methotrexate, cytarabine, and thiotepa have been widely studied as traditional IT therapies. In recent years, the advent of novel anti-tumor drugs has led to a growing number of agents being employed for IT administration in the treatment of malignant tumors with LMD. This article presents a comprehensive review of the current advancements in IT administration of chemotherapy drugs, targeted drugs, and immunotherapy drugs for the treatment of LMD in solid tumors. In addition, we also discuss the safety issues of IT therapy, summarize the advantages of IT administration of different types of anti-tumor drugs, and put forward some suggestions for reducing adverse reactions. It is hoped that future research will focus on exploring more potentially effective anti-tumor drugs for IT treatment and conducting in-depth pharmacokinetic studies, and develop long-acting and low-toxic IT administration regimens for the treatment of meningeal metastases.

    Keywords: solid tumors, Leptomeningeal disease, Intrathecal therapy, Chemotherapy drugs, immunotherapy drugs, Targeted drugs, Anti-tumor drugs

    Received: 30 Jul 2024; Accepted: 08 Jan 2025.

    Copyright: © 2025 Wang, Yao, Quan and Zhou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Junxiang Zhou, Sichuan Cancer Hospital, Chengdu, 610041, Sichuan Province, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.