High-dose methotrexate for metastatic breast cancer to the central nervous system: a single-institution review of forty-six patients (P3.134)

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Objective The prognosis for patients with metastatic breast cancer to the central nervous system (CNS) is poor. Methotrexate (MTX) is an active agent in the treatment of breast cancer & penetrates the CNS at high doses & rapid rate of infusion. Methods We performed an IRB approved retrospective review of patients treated at Northwestern from 8/1/2003 to 12/31/2013. Demographic data collected included date of diagnosis, time to CNS metastases, Karnofsky Performance Status, HER-2 & hormone status, radiographic and/or cytologic response to MTX, progression-free survival (PFS) & overall survival (OS). Results Forty-six patients met criteria for inclusion. All patients were women with a median age of 49 (range 28-80) and average KPS of 70 (range: 20-100). Median number of doses was 4 (range 1-22),dosed at 3.5 gm/m2. The median PFS and OS were 3.4 and 4.1 months (m). Patients with ER/PR- disease had median PFS/OS of 5.2m/8.7m (Her2-) & 1.2m/3.0m (Her2 +). Patients with ER/PR+ disease had median PFS/OS of 3.4m/4.1m (Her2 -) & 3.4m/3.8m (Her2 +). When response was evaluated based on KPS, PFS/OS rates are 6.8m/15.2m for patients with KPS蠅70. Patients with KPS<70 had PFS/OS rates of 3.2m/4.0m. Six patients are alive after completing MTX treatment and continue systemic therapies. There were 34 patients with scans for treatment evaluation: 1 complete response, 3 partial responses, & 16 patients had stable disease. Most common toxicities were anemia, hypokalemia, mucositis, transient elevations in liver enzymes, & thrombocytopenia. Conclusion High-dose intravenous methotrexate remains a treatment option for patients with CNS metastases of breast cancer. Patients with ER/PR negative disease trended toward better PFS & OS. Patients with KPS less than 70 may not warrant treatment given shorter survival.

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