In two to five percent of women with breast cancer, tumor cells migrate into the spinal fluid invading the tissue surrounding the brain and spinal cord called the meninges. While a rare complication, the condition is challenging because there is no agreed-upon standard of treatment, leaving little hope for patients affected. Northwestern Medicine- researchers are currently examining a novel approach to delivering an FDA approved drug that they hope will advance research for this type of cancer and lead to discoveries that may improve outcomes in the future.
As part of the clinical trial, the drug Trastuzumab is directly injected into the spinal fluid in hopes of stopping the growth of the cancer cells in patients with HER-2 positive breast cancer. Jeffrey Raizer, MD, co-director of the Northwestern Brain Tumor Institute (NBTI), is the principal investigator for trial which he developed. NBTI is part of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University at Northwestern Memorial Hospital.
"When cancer spreads to the spinal fluid and tissues surrounding the brain, called leptomeningeal metastases (LM), there are very limited therapeutic options," said Raizer, who is also medical director of neuro-oncology at Northwestern Memorial and associate professor of neurology at Northwestern University Feinberg School of Medicine. "This rare condition typically occurs in later stages of cancer and often the benefits of treatment are small and may be counteracted by its side effects. For women with HER-2 positive breast cancer, they often have well-controlled disease in their body when this complication occurs."
Raizer explains that drugs cannot easily penetrate from the blood stream into the spinal fluid because of the blood brain barrier, making the condition difficult to treat. In this trial, the antibody will be delivered directly into the spinal fluid using a device that is placed under the scalp called an Ommaya reservoir. A small catheter is inserted into a fluid-filled space allowing fluid to be removed and for the drug to be instilled into it.