Triple intraventricular chemotherapy for treatment of relapsed choroid plexus carcinoma.

Abstract

Limited evidence for the optimal management of relapsed choroid plexus carcinoma (CPC) exists, with a few case reports involving surgery, radiotherapy and intravenous chemotherapy. However, the safety and tolerability of intraventricular chemotherapy in this setting has not been widely studied. We describe a case where triple intraventricular chemotherapy was administered to a child with relapsed metastatic CPC. A 7-year-old male with a history of CPC presented with relapsed metastatic disease. At initial diagnosis at 4 years of age, treatment involved gross total resection of an intraventricular mass in the left temporal region followed by chemotherapy and autologous stem cell transplantation (SCT) according to HEADSTART II-D. One year after SCT, craniospinal radiation was delivered following radiological relapse, achieving a partial response. Given previous treatmentlimiting myelosuppression, intraventricular chemotherapy via Ommaya reservoir with thiotepa 5mg, etoposide 0.5mg and topotecan 0.4mg twice a week (non-weight-based dosing) was commenced taking into consideration pharmaceutical formulation aspects for optimal intraventricular drug delivery. After six cycles of intraventricular chemotherapy, palliative radiotherapy was administered due to radiological progression. Following completion, weekly triple intraventricular chemotherapy continued for 9 months. The patient remained out of hospital with the main side effects being fatigue and occasional nausea amenable to ondansetron. This case study demonstrates the safety and tolerability of a triple intraventricular chemotherapy regimen used to delay disease progression and prolong quality of life in a child with relapsed CPC in the palliative setting. This could provide an alternative treatment regimen for patients with relapsed disease.