Abstract
Background: Lung cancer is one of the neoplasms that most frequently spreads to the meninges and currently there is no consensus or standard management of this condition. Intrathecal chemotherapy (IC) has been adopted as an attempt to reach disease control, however real-world data regarding the efficacy of this therapeutic approach is yet to be described in literature.
Aim: To evaluate the impact of intrathecal chemotherapy on overall survival (OS) of patients with lung cancer and leptomeningeal carcinomatosis in a contemporary and real-world setting.
Methods: Our study was performed by using TriNetX, a global health network dataset of electronic medical records of patients from 101 healthcare organizations around the world. We queried for patients with specific terms between January 2003 and March 2023 and performed a propensity score matching (PSM) analysis for cohort balancing. Cohort 1 enrolled patients submitted to IC while cohort 2 enrolled patients not receiving IC during their treatment pathway. OS was estimated by Kaplan–Meier and log-rank test was applied.
Results: After initial query and propensity score matching, 139 patients were selected in each cohort. Methotrexate (42%) and Cytarabine (32%) were the most frequent treatment received by patients and the most common sequence of treatment that patients followed during their treatment pathway. Median overall survival was 109 days in intrathecal chemotherapy (cohort 1) and 280 days in those who did not receive intrathecal chemotherapy (cohort 2), with a Hazard Ratio of 1.538 (95% CI 1.148 - 2.060) and log rank test providing a x2 of 8.462 with p= 0.004.
Conclusions: In despite of the limitations inherent of a real-world data analysis, our study revealed that intrathecal chemotherapy had a detrimental effect on overall survival with increased risk of death among lung cancer patients having leptomeningeal carcinomatosis.