Vascular Investigation and Therapy

: 2019  |  Volume : 2  |  Issue : 4  |  Page : 105--106

Intraventricular chemotherapy and nonsmall cell lung carcinoma

Jamir Pitton Rissardo, Ana Letícia Fornari Caprara 
 Department of Neurology, Federal University of Santa Maria, Santa Maria, RS, Brazil

Correspondence Address:
Jamir Pitton Rissardo
Rua Roraima, Santa Maria, Rio Grande do Sul

How to cite this article:
Rissardo JP, Fornari Caprara AL. Intraventricular chemotherapy and nonsmall cell lung carcinoma.Vasc Invest Ther 2019;2:105-106

How to cite this URL:
Rissardo JP, Fornari Caprara AL. Intraventricular chemotherapy and nonsmall cell lung carcinoma. Vasc Invest Ther [serial online] 2019 [cited 2020 Oct 25 ];2:105-106
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Dear Editor,

We read the article entitled, “Multiple intraventricular brain metastasis in a case of non-small cell lung carcinoma” on the esteemed “Vascular Investigation and Therapy” with great interest. Kaur et al. reported a case of an elderly male who was diagnosed with nonsmall cell lung cancer presenting with headache and dysarthria. A cranial computed tomography revealed lesions in the intraventricular region, suggestive of brain metastasis.[1]

As Kaur et al. stated metastasis to the choroid plexus, ventricles, pituitary gland, or leptomeninges are rare, and when encountered in the clinical practice, the treatment is a tough decision.[1] In this context, adenocarcinomas are the most common solid tumors to metastasize to the meninges. When lung cancer is analyzed, more than three-quarters of these metastases are related to adenocarcinoma histopathology.[2] The development of new therapeutic options for the systemic treatment of nonsmall cell lung cancer is changing the landscape of this rapidly fatal clinical condition.[3] Herein, we would like to discuss more the leptomeningeal metastasis and intraventricular chemotherapy.

In a recent literature review by Cheng and Perez-Soler, they conclude that more research is needed to understand the biology of the leptomeningeal metastatic development and the drug resistance pathophysiological mechanism. In their management opinion, the patient should already know if he/she is epidermal growth factor receptor (EGFR)-mutant or anaplastic lymphoma kinase-positive because this characterization will divide the treatment in two ways in association with radiotherapy when a diagnosis of leptomeningeal metastasis is done. They also separate the drugs into nonsubstrate-dependent (AZD3759, alectinib) and substrate-dependent (others) based on their efflux transport by p-glycoprotein and breast cancer resistance protein. It is worthy of mentioning that we have more than ten studies that assessed EGFR tyrosine kinase inhibitors, but the data provided by them are still not clear and the statistical power is presumably low, because, in more than 90%, the number of patients in the studies was <30 or the charts were only assessed retrospectively.[4]

Gwak et al. retrospectively studied the outcome of intraventricular management in leptomeningeal carcinomatosis from nonsmall cell lung cancer in more than 100 patients. They found that the elderly, Karnofsky performance score, and uncontrolled intracranial pressure are the prognostic factors for poor outcome. Moreover, even though the median overall survival was of 3 months and a negative conversion of cerebrospinal fluid cytology was observed only in about 8% of the patients, the intraventricular chemotherapy amount significantly improved the overall survival in the multivariate analysis. Therefore, the intraventricular chemotherapy technique not only relieves the symptom but also could increase the survival period in this specific group of patients.[5]

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1Kaur R, Aggarwal S, Gadhavi S, Dahuja A, Singh P. Multiple intraventricular brain metastasis in a case of non-small cell lung carcinoma. Vasc Investig Ther 2019;2:82.
2Chamberlain MC. Neoplastic meningitis. J Clin Oncol 2005;23:3605-13.
3Christoph DC, Reckamp KL. Intraventricular chemotherapy for leptomeningeal carcinomatosis from lung cancer: A feasible and beneficial treatment option? J Thorac Oncol 2013;8:523-4.
4Cheng H, Perez-Soler R. Leptomeningeal metastases in non-small-cell lung cancer. Lancet Oncol 2018;19:43-55.5.
5Gwak HS, Joo J, Kim S, Yoo H, Shin SH, Han JY, et al. Analysis of treatment outcomes of intraventricular chemotherapy in 105 patients for leptomeningeal carcinomatosis from non-small-cell lung cancer. J Thorac Oncol 2013;8:599-605.