Leptomeningeal Carcinomatosis

Leptomeningeal Carcinomatosis

Approximately 5% of patients with cancer develop leptomeningeal metastases (LM). As increasing numbers of patients with cancer survive longer and our diagnostic imaging improves, LM is being diagnosed more frequently and estimated at 30,000 US cases annually, with a median survival of 4-6 weeks without treatment. Current treatment involves radiation to symptomatic sites of the neuraxis and to sites of bulk disease seen on imaging. Intrathecal (IT) chemotherapy is designed to treat tumor cells in the CSF, preventing the development of new symptomatic sites of disease. Systemically administered chemotherapy has limited access to the CSF due to the blood–brain barrier (BBB). IT agents, such as methotrexate, thiotepa, cytarabine or topotecan, are typically infused through a ventricular reservoir and depend on passive diffusion for distribution. Neurpheresis poses a novel approach to rapidly clear the CSF of tumor cells and circulate tailored chemotherapeutic agents to enhance systemic treatment in an effort to reduce the high mortality of LM and extend survival.
Key Collaborators
Emil Lou
Assistant Professor of Medicine, Division of Hematology, Oncology and Transplantation
University of Minnesota

After completing undergraduate studies in biochemistry at SUNY College at Geneseo, Dr. Lou received his M.D. and Ph.D. degrees (Microbiology and Immunology) from SUNY Upstate Medical University in 2004. He performed his residency training in Internal Medicine at Duke University Medical Center and then subsequently completed his Medical Oncology and Hematology fellowship at the Memorial Sloan-Kettering Cancer Center in 2010. He also completed an additional fellowship in Neuro-Oncology at the Preston Robert Tisch Brain Tumor Center at Duke.

Dr. Lou, a diplomate of the American Board of Internal Medicine, is board certified in Medical Oncology and Internal Medicine. In addition he is also board certified in Neuro-Oncology through the United Council for Neurologic Subspecialties. He joined the faculty in the Division of Hematology, Oncology and Transplantation in 2011 and is a member of the Masonic Cancer Center, University of Minnesota.

Clark Chen
Professor, Lyle French Chair in Neurosurgery and Department Head
University of Minnesota

Dr. Chen is a nationally recognized brain tumor researcher and surgeon, with a dedicated interest in understanding how glioblastomas acquire resistance to radiation and chemotherapy. He is an NIH RO1-funded investigator whose research focuses on developing novel diagnostic and therapeutic approaches for brain tumor patients. He is also a leader in the study of DNA repair and gene therapy in brain tumors.

The recipient of several highly competitive research awards, Dr. Chen has won the Damon Runyon Fellowship Award, the Sidney Kimmel Scholar Award, the Burroughs Wellcome Foundation Career Award in Medical Sciences, the Sontag Foundation Distinguished Scientist Award, the Doris Duke Foundation Clinical Scientist Award, and the Forbeck Scholar Award. His laboratory is housed in the University of Minnesota Masonic Cancer Center.

In 2016, Dr. Chen received the Presidential Award of Achievement from the President of Taiwan, Ma Ying-jeou. The award is given annually by the Taiwanese government to individuals of Taiwanese heritage who have made exceptional contributions to their profession.

Collaborating and Supporting Researchers
  • Kimberly Blackwell, MD – Professor of Medicine, Duke Cancer Institute
  • Peter Fecci, MD, PhD – Assistant Professor of Neurosurgery, Duke Cancer Institute
  • Darrell Bigner, MD, PhD – Edwin L. Jones, Jr. and Lucille Finch Jones Cancer Research Professor; Director, Preston Robert Tisch Brain Tumor Center, Duke University Medical Center)
  • Michael Cohen-Wolkowiez, MD, PhD – Director, Pharmacometrics Center, Duke Clinical Research Institute
  • Ivan Spasojevic, PhD – Associate Professor of Medicine, Department of Medicine-Oncology, Duke University School of Medicine