Abstract
Brain tumors with an oligodendroglial component represent up to 20% of all primary brain tumors. Many of these tumors are sensitive to procarbazine, lomustine and vincristine (PCV), or temozolomide (TMZ) chemotherapy. In patients with oligodendroglial tumors that are resistant to PCV or TMZ chemotherapy, few treatment options are available and improved therapy is needed. One strategy, administration of chemotherapy via the intra-arterial (IA) route, can result in a higher concentration of drug delivery to the brain and brain tumor cells, with a lower systemic exposure, resulting in increased tumor-specific cytotoxicity, and avoidance of systemic toxicities. Osmotic blood-brain barrier disruption (BBBD), achieved by IA infusion of a hyperosmotic agent such as mannitol, can further intensify drug delivery to the tumor and surrounding brain, particularly in smaller, less permeable tumors and when using higher-molecular weight chemotherapy agents. General experience with IA chemotherapy, and IA chemotherapy combined with BBBD in patients with many tumor types is extensive. In the case of aggressive oligodendroglial tumors, hopeful results have been reported using combination delivery of IA chemotherapy (IA melphalan, IA carboplatin and IV etoposide phosphate) in conjunction with BBBD, with acceptably low toxicity and encouraging response data in many patients. Delivery of chemotherapy via the IA route, in conjunction with BBBD may be a good option in those with aggressive oligodendroglial tumors. Further work is required to uncover the true potential of IA therapy in the setting of aggressive oligodendroglial tumors.
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References
Angelov L, Doolittle ND, Kraemer DF, Siegal T, Barnett GH, Peereboom DM, Stevens G, McGregor J, Jahnke K, Lacy CA, Hedrick NA, Shalom E, Ference S, Bell S, Sorenson L, Tyson RM, Haluska M, Neuwelt EA (2009) Blood-brain barrier disruption and intra-arterial methotrexate-based therapy for newly diagnosed primary CNS lymphoma: a multi-institutional experience. J Clin Oncol 27:3503–3509
Basso U, Lonardi S, Brandes AA (2002) Is intra-arterial chemotherapy useful in high-grade gliomas. Expert Rev Anticancer Ther 2:507–519
Bromberg JE, van den Bent MJ (2009) Oligodendrogliomas: molecular biology and treatment. Oncologist 14:155–163
Cairncross G, Macdonald D, Ludwin S, Lee D, Cascino T, Buckner J, Fulton D, Dropcho E, Stewart D, Schold C Jr, Wainman N, Eisenhauer E (1994) Chemotherapy for anaplastic oligodendroglioma. National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 12:2013–2021
Cairncross JG, Ueki K, Zlatescu MC, Lisle DK, Finkelstein DM, Hammond RR, Silver JS, Stark PC, Macdonald DR, Ino Y, Ramsay DA, Louis DN (1998) Specific genetic predictors of chemotherapeutic response and survival in patients with anaplastic oligodendrogliomas. J Natl Cancer Inst 90:1473–1479
Cairncross G, Berkey B, Shaw E, Jenkins R, Scheithauer B, Brachman D, Buckner J, Fink K, Souhami L, Laperierre N, Mehta M, Curran W (2006) Phase III trial of chemotherapy plus radiotherapy compared with radiotherapy alone for pure and mixed anaplastic oligodendroglioma: Intergroup Radiation Therapy Oncology Group Trial. J Clin Oncol 24:2707–2714
Cloughesy TF, Gobin YP, Black KL, Vinuela F, Taft F, Kadkhoda B, Kabbinavar F (1997) Intra-arterial carboplatin chemotherapy for brain tumors: a dose escalation study based on cerebral blood flow. J Neurooncol 35:121–131
Doolittle ND, Miner ME, Hall WA, Siegal T, Jerome E, Osztie E, McAllister LD, Bubalo JS, Kraemer DF, Fortin D, Nixon R, Muldoon LL, Neuwelt EA (2000) Safety and efficacy of a multicenter study using intraarterial chemotherapy in conjunction with osmotic opening of the blood-brain barrier for the treatment of patients with malignant brain tumors. Cancer 88:637–647
Dropcho EJ, Rosenfeld SS, Morawetz RB, Vitek J, Brothers M, Gorum T, Bell S, Gillespie GY, Glantz M, Mahaley MS Jr et al (1992) Preradiation intracarotid cisplatin treatment of newly diagnosed anaplastic gliomas. The CNS Cancer Consortium. J Clin Oncol 10:452–458
Eckman WW, Patlak CS, Fenstermacher JD (1974) A critical evaluation of the principles governing the advantages of intra-arterial infusions. J Pharmacokinet Biopharm 2:257–285
Gebarski SS, Greenberg HS, Gabrielsen TO, Vine AK (1984) Orbital angiographic changes after intracarotid BCNU chemotherapy. AJNR Am J Neuroradiol 5:55–58
Guillaume DJ, Doolittle ND, Gahramanov S, Hedrick NA, Delashaw JB, Neuwelt EA (2010) Intra-arterial chemotherapy with osmotic blood-brain barrier disruption for aggressive oligodendroglial tumors: results of a phase I study. Neurosurgery 66:48–58
Ino Y, Betensky RA, Zlatescu MC, Sasaki H, Macdonald DR, Stemmer-Rachamimov AO, Ramsay DA, Cairncross JG, Louis DN (2001) Molecular subtypes of anaplastic oligodendroglioma: implications for patient management at diagnosis. Clin Cancer Res 7:839–845
Jahnke K, Kraemer DF, Knight KR, Fortin D, Bell S, Doolittle ND, Muldoon LL, Neuwelt EA (2008) Intraarterial chemotherapy and osmotic blood-brain barrier disruption for patients with embryonal and germ cell tumors of the central nervous system. Cancer 112:581–588
Kroll RA, Neuwelt EA (1998) Outwitting the blood-brain barrier for therapeutic purposes: osmotic opening and other means. Neurosurgery 42:1083–1099
Kroll RA, Pagel MA, Muldoon LL, Roman-Goldstein S, Fiamengo SA, Neuwelt EA (1998) Improving drug delivery to intracerebral tumor and surrounding brain in a rodent model: a comparison of osmotic versus bradykinin modification of the blood-brain and/or blood-tumor barriers. Neurosurgery 43:879–886
Levin VA, Kabra PM, Freeman-Dove MA (1978) Pharmacokinetics of intracarotid artery 14C-BCNU in the squirrel monkey. J Neurosurg 48:587–593
Mohile NA, Forsyth P, Stewart D, Raizer JJ, Paleologos N, Kewalramani T, Louis DN, Cairncross JG, Abrey LE (2008) A phase II study of intensified chemotherapy alone as initial treatment for newly diagnosed anaplastic oligodendroglioma: an interim analysis. J Neurooncol 89:187–193
Mortimer JE, Crowley J, Eyre H, Weiden P, Eltringham J, Stuckey WJ (1992) A phase II randomized study comparing sequential and combined intraarterial cisplatin and radiation therapy in primary brain tumors. A Southwest Oncology Group study. Cancer 69:1220–1223
Muldoon LL, Soussain C, Jahnke K, Johanson C, Siegal T, Smith QR, Hall WA, Hynynen K, Senter PD, Peereboom DM, Neuwelt EA (2007) Chemotherapy delivery issues in central nervous system malignancy: a reality check. J Clin Oncol 25:2295–2305
Neuwelt EA, Barnett PA, McCormick CI, Remsen LG, Kroll RA, Sexton G (1998) Differential permeability of a human brain tumor xenograft in the nude rat: impact of tumor size and method of administration on optimizing delivery of biologically diverse agents. Clin Cancer Res 4:1549–1555
Neuwelt EA, Gilmer-Knight K, Lacy C, Nicholson HS, Kraemer DF, Doolittle ND, Hornig GW, Muldoon LL (2006) Toxicity profile of delayed high dose sodium thiosulfate in children treated with carboplatin in conjunction with blood-brain-barrier disruption. Pediatr Blood Cancer 47:174–182
Neuwelt E, Abbott NJ, Abrey L, Banks WA, Blakley B, Davis T, Engelhardt B, Grammas P, Nedergaard M, Nutt J, Pardridge W, Rosenberg GA, Smith Q, Drewes LR (2008) Strategies to advance translational research into brain barriers. Lancet Neurol 7:84–96
Newton H (2006) Intra-arterial chemotherapy. In: Newton H (ed) Handbook of brain tumor chemotherapy. Elsevier, London
Perry JR, Louis DN, Cairncross JG (1999) Current treatment of oligodendrogliomas. Arch Neurol 56:434–436
Shapiro WR, Green SB, Burger PC, Selker RG, VanGilder JC, Robertson JT, Mealey J Jr, Ransohff J, Mahaley MS Jr (1992) A randomized comparison of intra-arterial versus intravenous BCNU, with or without intravenous 5-fluorouracil, for newly diagnosed patients with malignant glioma. J Neurosurg 76:772–781
Siegal T, Rubinstein R, Bokstein F, Schwartz A, Lossos A, Shalom E, Chisin R, Gomori JM (2000) In vivo assessment of the window of barrier opening after osmotic blood-brain barrier disruption in humans. J Neurosurg 92:599–605
Stewart D (1991) Intra-arterial chemotherapy of primary and metastatic brain tumors. In: Rottenberg D (ed) Neurological complications of cancer treatment. Butterworth-Heinimann, Boston, pp 143–170
Stewart DJ, Belanger JM, Grahovac Z, Curuvija S, Gionet LR, Aitken SE, Hugenholtz H, Benoit BG, DaSilva VF (1992) Phase I study of intracarotid administration of carboplatin. Neurosurgery 30:512–516
Tyler JL, Yamamoto YL, Diksic M, Theron J, Villemure JG, Worthington C, Evans AC, Feindel W (1986) Pharmacokinetics of superselective intra-arterial and intravenous [11C]BCNU evaluated by PET. J Nucl Med 27:775–780
van den Bent MJ (2007) Anaplastic oligodendroglioma and oligoastrocytoma. Neurol Clin 25:1089–1109, ix–x
van den Bent MJ, Kros JM, Heimans JJ, Pronk LC, van Groeningen CJ, Krouwer HG, Taphoorn MJ, Zonnenberg BA, Tijssen CC, Twijnstra A, Punt CJ, Boogerd W (1998) Response rate and prognostic factors of recurrent oligodendroglioma treated with procarbazine, CCNU, and vincristine chemotherapy. Dutch Neuro-oncology Group. Neurology 51:1140–1145
van den Bent MJ, Taphoorn MJ, Brandes AA, Menten J, Stupp R, Frenay M, Chinot O, Kros JM, van der Rijt CC, Vecht Ch J, Allgeier A, Gorlia T (2003) Phase II study of first-line chemotherapy with temozolomide in recurrent oligodendroglial tumors: the European Organization for Research and Treatment of Cancer Brain Tumor Group Study 26971. J Clin Oncol 21:2525–2528
van den Bent MJ, Carpentier AF, Brandes AA, Sanson M, Taphoorn MJ, Bernsen HJ, Frenay M, Tijssen CC, Grisold W, Sipos L, Haaxma-Reiche H, Kros JM, van Kouwenhoven MC, Vecht CJ, Allgeier A, Lacombe D, Gorlia T (2006) Adjuvant procarbazine, lomustine, and vincristine improves progression-free survival but not overall survival in newly diagnosed anaplastic oligodendrogliomas and oligoastrocytomas: a randomized European Organisation for Research and Treatment of Cancer phase III trial. J Clin Oncol 24:2715–2722
Williams PC, Henner WD, Roman-Goldstein S, Dahlborg SA, Brummett RE, Tableman M, Dana BW, Neuwelt EA (1995) Toxicity and efficacy of carboplatin and etoposide in conjunction with disruption of the blood-brain tumor barrier in the treatment of intracranial neoplasms. Neurosurgery 37:17–27
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Guillaume, D., Doolittle, N., Neuwelt, E. (2014). Oligodendroglial Tumors: Intra-arterial Chemotherapy. In: Hayat, M. (eds) Tumors of the Central Nervous System, Volume 13. Tumors of the Central Nervous System, vol 13. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-7602-9_2
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