Continuous Chemotherapy for Cancer Cells in Cerebrospinal Fluid

Cancer Treatment: Treatment for Cancer Cells in Cerebrospinal Fluid

Hello Dr.
Chen: My wife was diagnosed with a recurrence of breast cancer at the end of last year after six years.
Cancer cells were found in her cerebrospinal fluid, and she is currently undergoing her fifth round of chemotherapy at National Taiwan University Hospital, receiving targeted therapy and two types of chemotherapy, including treatment for the brain with Amaya.
This month, tests showed that there are no cancer cells in the cerebrospinal fluid, and her condition is under control.
Recently, I asked the doctor when the chemotherapy treatment would end, and the doctor replied: "It will not end; it will continue until you no longer want to do it.
It can only be paused for a short period; chemotherapy must be continuous." I was quite shocked by this news.
I would like to ask if this is true.
Here are my questions:
1.
Is it true that cancer cells in the cerebrospinal fluid cannot be treated like other cancers, and is there a fixed number of chemotherapy sessions or duration for treatment?
2.
Are the current chemotherapy and targeted drugs ineffective against the cancer cells in the cerebrospinal fluid, meaning they cannot kill the cancer cells but only control them? If they are ineffective, then why did the tests show that the cancer cells have gone from present to absent?
3.
Besides chemotherapy, are there any other treatment options available? For example, immunotherapy or stem cell therapy (I have stored cord blood from my child’s birth).
I do not doubt the treatment methods of the doctors at National Taiwan University; I just cannot understand how one can endure lifelong continuous chemotherapy.
I fear that the toxicity of chemotherapy may lead to death.
I do not understand medicine and am perplexed, so I would like to know the reasons behind this.
I would appreciate it if Dr.
Chen could take the time to explain this to me.
Thank you!

Chen Shunqing, 50~59 year old female. Ask Date: 2017/04/01

Dr. Chen Sirong reply Oncology

Chen Shunqing / 56 years old / Male
0.
I am quite shocked to hear this.
Is this true?
A: In terms of Western medicine, once the disease has spread, it is considered incurable.
Medications can only control it, which is a blessing.
How long it can be controlled is also a blessing.
First-line medications may control the disease for a period of time, and if ineffective, a second-line medication will be used.
If that also becomes ineffective, a third-line medication will be tried, and this continues until the patient's body can no longer tolerate treatment or there are no more medications available.
1.
Can cancer cells in the cerebrospinal fluid be treated like other cancers? Is there a fixed number of chemotherapy cycles or duration?
A: Essentially, chemotherapy for metastatic disease is different from adjuvant chemotherapy after complete surgical resection.
Adjuvant chemotherapy has a defined course, and once completed, the patient is monitored.
If the cancer has metastasized throughout the body and into the bloodstream, without treatment (chemotherapy, hormone therapy, or targeted therapy), it will continue to progress.
2.
Currently, chemotherapy and targeted drugs are ineffective against cancer cells in the cerebrospinal fluid; they cannot kill the cancer cells and can only control them? If they are ineffective, why do tests show that cancer cells have gone from present to absent?
A: According to Western medical experience, if cancer cells are currently undetectable, it does not guarantee that there are no cells remaining.
As long as one cell survives, there is a risk of recurrence.
Tumors need to grow to 0.5-1 cm before they can be detected.
Just because tests show no cancer cells does not confirm that there are none in the brain.
If even one cancer cell resides in the nervous tissue, recurrence is inevitable, based on past experiences shared with the physician.
The doctor has instructed to convey all medical statistical results to you.
3.
Are there any other treatment options besides chemotherapy? For example, immunotherapy or stem cell therapy (I have stored cord blood from my child's birth)?
A: You can consult with your physician.
There are clinical trials available for lung cancer, but I have not heard of any for breast cancer that allows the use of one's child's stem cells.
Participating in clinical trials is not suitable, and self-administering stem cells may tread on legal boundaries.
Although I know laboratories that have such technology, it can be very costly and legally ambiguous.
In this public forum, I can only suggest that you inquire about any available clinical trials for stem cells.
Ultimately, entrust your life to fate, and accept whatever comes with peace and joy.
Taoyuan Hospital, Chen Sirong.

Reply Date: 2017/04/01

More Info

Dear Patient,
I understand your concerns regarding your wife's ongoing chemotherapy treatment for recurrent breast cancer, especially with the presence of cancer cells in the cerebrospinal fluid (CSF). This situation can be quite complex and emotionally taxing, so I appreciate your desire for clarity. Let's address your questions one by one.

1. Cerebrospinal Fluid Cancer Cells and Treatment Duration: The presence of cancer cells in the CSF indicates a more advanced stage of cancer, often referred to as leptomeningeal carcinomatosis. This condition can be particularly challenging to treat, as the cancer cells can spread through the central nervous system. Unlike localized tumors, where chemotherapy may have a defined number of cycles, treatment for cancer in the CSF often requires a more prolonged approach. The goal is not only to eliminate the cancer cells but also to manage symptoms and maintain quality of life. Your doctor’s recommendation to continue treatment until you no longer wish to pursue it is a common approach in such cases, as the treatment is aimed at controlling the disease rather than achieving a complete cure.

2. Effectiveness of Current Treatments: It is important to clarify that while chemotherapy and targeted therapies may not completely eradicate cancer cells in the CSF, they can still be effective in controlling the disease. The fact that follow-up tests show no cancer cells in the CSF is a positive sign and suggests that the treatment is working to some extent. The absence of detectable cancer cells does not necessarily mean that all cancer cells have been killed; rather, it indicates that their levels are below the detection threshold. Continuous monitoring is essential, as cancer can be unpredictable, and the situation can change.

3. Alternative Therapies: In addition to chemotherapy, there are other treatment options available for managing cancer in the CSF. Immunotherapy is one such option that has gained traction in recent years. It works by enhancing the body's immune response against cancer cells. However, the effectiveness of immunotherapy can vary based on the specific characteristics of the cancer. Stem cell therapy, particularly using cord blood stem cells, is still largely experimental for treating metastatic cancers and may not be widely available or applicable in your wife's case. It is crucial to discuss these options with your oncologist, who can provide guidance based on the latest research and your wife's specific situation.

Your concerns about the long-term effects of chemotherapy are valid. Chemotherapy can have significant side effects, and the cumulative impact of ongoing treatment can be challenging. It is essential to have open discussions with your healthcare team about the goals of treatment, potential side effects, and quality of life considerations. Palliative care services can also be integrated into the treatment plan to help manage symptoms and improve comfort.

In conclusion, while the prospect of continuous chemotherapy may seem daunting, it is often necessary in cases where cancer has spread to the CSF. The focus is on controlling the disease and maintaining the best possible quality of life. I encourage you to continue communicating with your healthcare team, asking questions, and exploring all available treatment options. Your understanding and involvement in the decision-making process are vital for your wife's care.

Best wishes to you and your family during this challenging time.

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