Treatment and outcomes of breast cancer with leptomeningeal disease: Real-world experience in the African American population
Recommended Citation
Ghimire B, Jamil M, Girgis M. Treatment and outcomes of breast cancer with leptomeningeal disease: Real-world experience in the African American population. 2025; (16_suppl):e13106.
Document Type
Conference Proceeding
Publication Date
5-28-2025
Abstract
Background: Leptomeningeal disease (LMD) is a rare but devastating complication of malignancies, affecting up to 5% of breast cancer patients. Survival is poor, typically 4-5 months despite aggressive treatment. While the literature on LMD is limited, data on the African American (AA) population are even more scarce. This study examines clinical characteristics and outcomes of breast cancer patients with LMD, with a focus on AAs. Methods: We retrospectively reviewed breast cancer patients diagnosed with LMD at Henry Ford Health (August 2014–August 2024). LMD diagnosis followed ESMO criteria, and treatment responses were assessed using modified RANO-LM criteria. Results: Forty-one patients were identified (18 Caucasian, 17 AA, 6 others), with a median age of 52 at diagnosis. Hormone receptor (HR)- positive tumors were most common (46%), followed by HER2-positive and triple-negative (27% each). Most had invasive ductal histology (71%) and grade 3 tumors (32%), with 51% presenting with de novo stage IV disease. Among AAs, the median age at diagnosis was also 52; receptor subtypes were HER2-positive (29%), HR-positive (35%), and triple-negative (35%). A higher proportion of AAs had a better performance status (ECOG 1) compared to the overall cohort (44% vs 24%). 34% of all patients received intrathecal (IT) therapy, most commonly with methotrexate. HER2-positive patients received the most IT treatments (median: 23). Systemic therapy (received by 49%) frequently included capecitabine, while 49% underwent CNS radiation. AAs had lower rates of IT therapy (29%), systemic therapy (47%), and CNS radiation (41%). Among all, overall response and disease control rates were 15% and 34%, respectively. For AAs, these rates were slightly better at 24% and 41%. Median event-free survival (EFS) was 2.2 months for both the overall and AA populations. Median overall survival (OS) was similarly poor: 1.8 months overall, and 2.2 months in AAs. Among receptor subtypes, HER2-positive patients had better EFS (7.1 months), and OS (3.4 months) among all, though that difference was not seen in AAs (median not evaluable). Poor performance status predicted worse EFS and OS across all groups. Other factors, including histology, grade, stage at diagnosis, time to onset of LMD, concurrent parenchymal metastases, and metastatic burden, showed no significant impact on EFS and OS in the overall cohort or the AA subgroup. Conclusions: Our study highlights clinical differences between the AA population and the general cohort, particularly in receptor status, performance status, and treatment patterns. Although AAs had numerically better response rates, survival outcomes were similar in both groups. The aggressive nature of LMD underscores the limited effectiveness of available therapies, with few patients able to receive or benefit from multimodality treatment.
Issue
16_suppl
First Page
e13106
