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Leptomeningeal Breast — SCE Medical Oncology MCQ

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HardBreast CancerLeptomeningeal BreastSCE Medical Oncology

A 62-year-old woman with ER+/HER2- metastatic breast cancer develops leptomeningeal disease confirmed by CSF cytology. Her systemic disease is controlled on endocrine therapy. Which endocrine agent has the best CSF penetration?

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Correct answer: A — Abemaciclib with clinically relevant CNS penetration

Among CDK4/6 inhibitors, abemaciclib uniquely crosses the blood-brain barrier with clinically relevant CSF concentrations. It has demonstrated intracranial activity in breast cancer brain/leptomeningeal metastases. Palbociclib and ribociclib have negligible CNS penetration. For ER+/HER2- leptomeningeal disease, abemaciclib + endocrine therapy can provide CNS-directed activity. Intrathecal methotrexate remains complementary for cytologically-confirmed leptomeningeal disease.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer