My sister's stage IV lung cancer has now become Leptomeningeal. She was supposed to get intrathecal siposomal cytarabine today, but there was a mix up and Kaiser didn't have it ready this week. We don't think a delay in treatment is a good idea. Her doctor proposes methotrexate this week instead. Is this a viable option?
1) What is the current best, most promising treatment available for LM cancer? I notice that intrathecal chemo was not very popular with Dr. West a few years ago from older posts. Is this still true or has treatment improved?
2) Can Opdivo impact LM cancer? (My sister also started Opdivo last week).
3) Is methotrexate a viable option for just this week so that we are doing something? Her cancer is super aggressive. Are toxicities with this super high and scary? (My sister also receives Irinotecan to keep her lung tumor in check. Without weekly Irinotecan, her pain jumps out--of-control within days.