Intra Spinal Chemotherapy for Cancer

Patients with breast cancer that has metastasised to the meninges may now be treated with DepoCyt, a slow-release formulation of the cytotoxic drug, cytarabine. This treatment has been reported in studies published in October 2000( [1] ) and January 2001( [2] ). Both report encouraging therapeutic benefit in combating neoplastic meningitis in breast cancer, but cite arachnoiditis as one of the major adverse effects: 19% in one study, of which 88% were Grade 1 or 2 and "chemical arachnoiditis (i.e. headaches, fever, nausea, vomiting) was common". Despite a probably low survival (1 year survival projected as 19%) and the need for fewer injections (about a quarter the number needed in ?conventional' therapy) one must register concern as to the high incidence of arachnoiditis and the potential longer-term effects for those survivors. In May 2002, doctors from Florida published a paper ( [3] ) on an open label trial of DepoCyt for the intrathecal treatment of solid tumour neoplastic meningitis. They found that grade 3 or 4 arachnoiditis occurred on 6% of treatment cycles, and reported: "The most important adverse events were headache and arachnoiditis." METHOTREXATE: