Alternating sequential intracarotid BCNU and cisplatin in recurrent malignant glioma

Article Abstract:

High-grade gliomas are brain tumors with an undifferentiated appearance under the microscope; such tumors are extremely likely to spread, and the life expectancy for patients with high-grade gliomas is very poor. Gliomas pose a special problem for chemotherapy, since many anticancer drugs cannot enter the brain where they are needed, seriously limiting the choices of chemotherapeutic drugs. BCNU (carmustine) and cisplatin are two drugs which have some effectiveness against gliomas; some researchers have attempted to maximize the dose of these drugs by infusing them into the carotid arteries. The internal carotid arteries in the neck carry blood directly to the brain, and clinicians hope that much of the injected drug will get to the place where it does the most good. Researchers now report the results of the use of BCNU and cisplatin infused into the carotid artery in the treatment of high-grade gliomas. Since the toxic effects of the two drugs given together are unknown, the two drugs were administered on an alternating schedule. In keeping with other studies which have attempted to use the intracarotid method of administration, high levels of toxicity were found. The large number of toxic effects contributed to many patients failing to complete the study, thus hampering the interpretation of the results. For the 43 patients who started the study, the median survival time was nine months. The range of survival times extended from two weeks to six years. Four patients showed a partial response to the first infusion with BCNU and one patient showed a minor response to the next cycle of chemotherapy with cisplatin. Twenty-three patients experienced neurotoxicity, which was permanent in eight cases. Acute neurologic symptoms appearing during treatment included lethargy and one case of seizures. A case of aphasia and six other neurologic toxic effects developed within two weeks of treatment, and four patients developed neurologic effects more than two months after treatment. In addition to the neurological toxicity, 16 patients experienced toxic effects in the eyes; 13 patients experienced occlusion of the blood vessels in the eyes and 12 experienced a loss of visual sharpness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Gliomas

---

Continuous infusion of 5-fluorouracil with escalating doses of intermittent cisplatin and etoposide: a Phase I study

Article Abstract:

In most cases, once a cancer has spread to distant parts of the body, the only treatment option is chemotherapy. Unfortunately, chemotherapy is often not particularly effective against metastatic cancer, and for many cancers, including breast cancer, the treatment of metastatic disease is considered to be only palliative. A study was conducted to evaluate a chemotherapeutic protocol in 18 patients with metastatic cancer; 15 of the patients were women with metastatic breast cancer. The chemotherapeutic drugs cisplatin, etoposide, and 5-fluorouracil are all known to have some activity against breast cancer; the study therefore included all three agents in the therapeutic regimen. Laboratory studies suggest that 5-fluorouracil is more effective when administered very slowly over a long time rather than as a large single dose. Consequently, the chemotherapeutic regimen was designed to include an infusion of 5-fluorouracil that was continuous and maintained until signs of cancer progression were observed. During the treatment period, the patients also received intermittent doses of cisplatin and etoposide. The doses of these two drugs were gradually increased to determine the maximum dose that each patient could tolerate. While gastrointestinal side effects were common, it was the effects of the chemotherapy on the bone marrow that limited the dosages of the chemotherapeutic agents. Two of the patients in the present study, a woman with breast cancer and a man with pancreatic cancer, achieved complete responses to chemotherapy. In contrast with many patients with metastatic cancer, who have frequently received and relapsed after previous cycles of chemotherapy, these two patients responded to their first chemotherapeutic treatment. At present, their responses have persisted for longer than two months. The preliminary results obtained in this trial suggest that the chemotherapeutic protocol consisting of cisplatin, etoposide, and 5-fluorouracil may be useful in the treatment of metastatic cancer and should be evaluated in further studies. This regimen might prove to be a useful alternative to doxorubicin in the treatment of metastatic breast cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Breast cancer, Metastasis, Cancer metastasis, Fluorouracil

---

Intracarotid chemotherapy with etoposide and cisplatin for malignant brain tumors

Article Abstract:

In contrast with children, adults are more likely to develop high-grade glioma, a type of brain tumor. Low-grade gliomas have an appearance under the microscope which indicates less likelihood for spread. But high-grade gliomas have a great potential for rapid spread and the prognosis for high-grade gliomas is especially grim. The median survival for glioblastoma multiforme, a high-grade glioma, is eight months, and the 18-month survival rate is 15 percent. Chemotherapy is generally not effective, due to the blood-brain barrier, an interlocking barrier of cells which prevents most chemotherapeutic drugs from leaving the blood and entering the brain itself. The drug BCNU is generally used to treat gliomas, simply by virtue of its ability to pass through the blood-brain barrier. One way to deliver chemotherapeutic drugs in sufficient doses to kill brain tumors is to inject the drug via a catheter directly into the internal carotid artery or the vertebral artery, blood vessels which carry blood directly into the brain. Unfortunately, this technique seems to increase the toxic side effects at the same time as it increases therapeutic effectiveness. Based on previous experience, a study was designed to determine if the intra-arterial injection of a combination of cisplatin and etoposide could achieve therapeutic effectiveness against brain tumors without resulting in unacceptable levels of toxic effects. Twenty adults with high-grade gliomas were treated; also treated were 28 patients with brain tumors resulting from the spread of systemic cancers to the brain, including 18 cases of metastatic lung cancer in the brain. For the patients with high-grade glioma, the median survival time was 14 months. For the patients with metastatic brain tumors, six achieved complete responses to the chemotherapeutic treatment and six had partial responses; the median survival was seven months. These results indicate that some effectiveness against brain tumors may be achieved with acceptable levels of toxicity using this drug combination. (Consumer Summary produced by Reliance Medical Information, Inc.)

Brain tumors

Similar abstracts:

• Abstracts: An aromatase-producing sex-cord tumor resulting in prepubertal gynecomastia. A 60-year-old man with persistent gynecomastia after excision of a pituitary adenoma
• Abstracts: Resuscitation of the newborn. Apnoea, bradycardia, and oxygen saturation in preterm infants. Endotracheal resuscitation of neonates using a rebreathing bag
• Abstracts: Dietary management of D-lactic acidosis in short bowel syndrome
• Abstracts: National health care reform: an aura of inevitability is upon us. National health care reform: the aura of inevitability intensifies
• Abstracts: Selenium in diet, blood, and toenails in relation to human health in a seleniferous area. Relation of Consumption of Vitamin E, Vitamin C, and Carotenoids to Risk for Stroke among Men in the United States

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.