Table 2.

Overview of Commonly Employed Treatments for Leptomeningeal Disease

Modality	Treatment	Overview
Surgery	Ventriculoperitoneal shunting	Symptomatic management of increased intracranial pressure
Radiation	Craniospinal radiation Whole brain radiation Focal radiation	Symptomatic relief and improvement in neurologic function, but no survival benefit
Intrathecal Chemotherapy	Methotrexate Cytarabine Thiotepa	Similar efficacy across single-agents; very limited data on multi-agent treatment
	Rituximab	60–76% response in patients with LM due to primary or secondary central nervous system lymphoma
	Trastuzumab	Possible efficacy in management of Her2+ breast cancer
Systemic Chemotherapy	High-dose IV methotrexate	Modest survival benefit
	Capecitabine	Case reports of efficacy in LM due to breast or esophageal cancer
	High-dose IV cytarabine	Limited efficacy in LM from solid organ tumors
	Temozolomide	Limited efficacy as single agent in LM from solid organ tumors
Targeted Chemotherapy	Dabrafenib Vemurafenib	Case reports suggesting efficacy in LM from BRAF V600E mutant melanoma naïve to BRAF inhibitor therapy
	Trametinib	Case reports suggesting efficacy in LM from BRAF V600E mutant melanoma naïve to MEK inhibitor therapy
	Osimertinib	Preclinical, phase I, and retrospective data suggesting efficacy in treating LM in patients with EGFR T790M-mutated NSCLC
	Alectinib Lorlatinib	Case reports suggesting efficacy in treating LM in patients with NSCLC with ALK chromosomal arrangement
	Bevacizumab	Addition to existing regimens in breast cancer and EGFR-driven NSCLC may improve CNS response in patients with LM

EGFR, epidermal growth factor receptor; LM, Leptomeningeal metastasis; NSCLC, non-small cell lung carcinoma; VEGF, vascular endothelial growth factor.