Julette F Batara | PubMed Health

PubMed2004

Current management of glioblastoma multiforme.

Glioblastoma multiforme is the most common primary brain tumor in adults. Despite major research efforts and progress in neuroimaging, neurosurgery, and radiation and medical oncology, the overall survival of patients with this disease has changed little over the past 30 years. Surgery and radiation therapy remain critical components in the care of patients with glioblastoma multiforme. Treatment with chemotherapy has been hampered by the apparent resistance of these tumor cells to available agents and challenges in delivering agents to the tumor cells. The blood-brain barrier can restrict entry of some agents and the effect of antiepileptic drugs inducing hepatic P450 can significantly affect the pharmacology of a wide range of antineoplastic agents. As a result, new agents and novel approaches are required. Translational research efforts should: (1) pursue a broad research agenda until productive avenues are identified; (2) quantify the delivery of novel agents to the malignant brain tumor cells; (3) determine the maximum tolerated dose (MTD) and preliminary efficacy data on novel agents before initiating combination therapies; (4) optimize trial designs; and (5) improve psychosocial and supportive care for patients with this devastating illness.

Antineoplastic Agents↗

PubMed2003

Primary central nervous system lymphomas.

PURPOSE OF REVIEW: Primary central nervous system lymphoma (PCNSL) is an aggressive B cell lymphoma that occurs in immunocompetent and immunosuppressed patients. Primary ocular lymphoma represents an important variant of this disease. The outcome for patients with PCNSL is rapidly improving with new treatment strategies. This review focuses on recent advances, investigations, and controversies in the management of these increasingly important malignancies. RECENT FINDINGS: The incidence of PCNSL is rising in immunocompetent patients over the age of 60 years for unexplained reasons. However, the incidence of AIDS-related PCNSL, which is related to Epstein-Barr virus infections, has fallen with the institution of highly active antiretroviral therapy. During the past decade, standard therapy has evolved from cranial irradiation to high dose methotrexate-based regimens. This shift in therapy has been associated with an increase in the median survival of patients from 1 year to longer than 3 years, and with an equally striking reduction in neurotoxicity if whole brain radiation is avoided. Optimal therapeutic results require careful attention to opportunistic infections, thromboembolic disease, and renal toxicities associated with high dose methotrexate. SUMMARY: Overall, PCNSLs are increasing in frequency and the results of therapy for this disease have dramatically improved during the past decade. Many important therapeutic questions remain unanswered. These include the optimal dose, frequency, and duration of methotrexate, as well as the roles of additional systemic chemotherapy drugs, intrathecal therapy, and cranial irradiation. Further progress in this uncommon disease will depend on entering patients into carefully designed multicenter clinical trials to build upon the significant advances that have been made.

Antimetabolites, Antineoplastic↗