LMD-08. Precision medicine for Leptomeningeal Carcinomatosis: a case report

Abstract

\n Leptomeningeal disease (LMD) is an aggressive late-stage event in cancer. It is rare in gynecological malignancies. We present a case of a patient diagnosed with cervical adenocarcinoma grade III, stage Ib1 who developed LMD treated with immunotherapy based on modern molecular medicine.\n The patient is 61-year-old female diagnosed with locally advanced cervical adenocarcinoma in November of 2017 and was rendered without evidence of disease after combined chemotherapy and pelvic irradiation. One year after initial treatment, she was found to have a solitary right cerebellar lesion on MRI for which she underwent gross total resection followed by stereotactic radiosurgery to the resection cavity. The pathology of the lesion was consistent with metastatic carcinoma of cervical primary. Next generation sequencing was performed on the brain metastasis tissue and was notable for a high tumor mutational burden (tTMB-high). One year after surgery she developed left arm weakness, and vertical diplopia. She underwent MRI of the brain and spine that demonstrated new nodular enhancement within the folia of the vermis and multi-level leptomeningeal enhancement in the cervical spine, consistent with LMD. She was treated for LMD with radiation to the whole brain and cervical spine. Radiation was followed with single-agent Pembrolizumab due to the reported response in cancer patients with tTMB-high status to immunotherapy. She is currently 6 months from her initial LMD diagnosis and is clinically stable with radiographic improvement.\n This case presents an extremely rare complication of cervical cancer. It also highlights a unique treatment option for patients with LMD found to have tTMB-high status. Immunotherapy is of particular interest in cases of cervical adenocarcinoma as this cancer commonly has moderately-high TMB. Several studies have investigated the response of leptomeningeal disease to immunotherapy with variable results, though none have evaluated the response of tumors with tTMB-high.