Alimta for Brain mets ? How effective ? - 1293213

Tue, 10/03/2017 - 19:13

Hello all

It is time again for some advice from this wonderful and knowledgeable team.
What is the efficiency of Alimta to cross the BBB ? I read that they are still trying to figure this out, but there seems to be evidence of acceptable BBB penetration from some patients whose brain mets have responded nicely .

What is your experience with this chemo agent in your patient population on their brain mets ?

The suggestion was made for me to move on to a carboplatin/ Alimta/ combo possibly remaining on Tagrisso also.

The reason for this : " there might be minimal leptomeningeal involvement of the medial left parietal lesion
I've been on Tagrisso for 17 months with rescue SRT to brain mets and lung mass to stretch out my time on Tagrisso.

My tumor load is probably still very low and ctDNA might not show up in the blood at this point.
There is also nothing to biopsy at this time.
The doc also said she did not want to put me through a lumbar puncture because of the often negative results .

Do you guys have any other ideas ? I'm still trying to stay away from WBR.
The doc was not to crazy about the ongoing Tesevatinib trial. I also would have to travel for this from Mass to Washington DC. She also did not think doubling up on Tagrisso would be preferable.
Last guardant liquid biopsy ( quite a while ago ) showed T740M went down to undetectable . Only original EGFR was still floating around .

Thanks so much for any input

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Hi Kempten,

I'm sorry to hear of this most recent scan finding, and I hope that it is an overcall, as it is at times in cases of suspected LMC. As you say, there are anecdotal and small population trial reports of good CNS response to Alimta, such as this report.

Despite these encouraging results, standard of care tends to remain radiation therapy, whether SRT or WBRT, depending on the extent of involvement. That being said, there is room for individualization in the choice of therapy. If the CNS lesions are asymptomatic, there is less reason to hurry on to WBRT, or even SRT. If chemotherapy is chosen, you would certainly want close follow-up radiologically and clinically, reporting any suspicious new symptoms quickly.

Finally, as I'm sure you know, if LMC is present, there are no clear-cut treatment choices that have proven widely effective. Pulsed regimens of targeted therapies, and even high doses of Alimta, have yielded some success for a subset of patients.

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Thank you so much Jim for responding .

I hope that the chemo combo has a positive effect for me . They are discussing amongst themselves on the tumor board . There might be different interpretations on the brain MRI results? regardless, Lepto will
the primary concern in my case especially since I was diagnosed with 9 brain mets right from the start .

I'll check in with you guys again and let you know what my response is to this treatment .

Thanks again



Hi Kempten,

With regard to interpretation of a brain MRI, LMC can be quite subtle in appearance. Since radiologists tend to be extremely careful in noting everything they see (or think they see), it can lead to overcalls. Of course, it is wise for you and your doctors to address the issue earlier rather than later.

Good luck with treatment.

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Hi Kemptem,

I don't have anything to add to Jim's excellent comments. I just wanted to let you know I'm sending positive vibes and cyber (((hugs))).


Thank you Jim and Janine

I pray it was an overcall.

Responding well to the chemo to buy some time would be fantastic.

Thanks for the well wishes and cyber-hugs