Chemotherapeutic dose intensification for treatment of malignant brain tumors: recent developments and future directions.
Despite a large amount of research on malignant brain tumors over the past 70 years, the prognosis for most tumor types is poor. One current focus of research is increasing dose intensity of chemotherapeutic agents. Various ways to increase dose intensity include high-dose chemotherapy followed by stem cell rescue (eg, bone marrow transplant), blood-brain barrier disruption or use of RMP7 to increase transvascular drug delivery, local delivery of chemotherapeutic agents (convection enhancement or clysis, antibody conjugates, and biodegradable polymers), chemoprotective agents, and tumor sensitizers. Improved identification of patients likely to respond to a given regimen may also increase the effectiveness of chemotherapy. We also discuss approaches to improve the design of nonrandomized trials by identifying and controlling potential confounding variables. This will improve the quality of individual studies and perhaps the comparability across studies.
Kraemer
Dale F
DF
Department of Neurology, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97201, USA.
Fortin
David
D
Neuwelt
Edward A
EA
D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001812:Blood-Brain Barrier / Q000187:drug effects / Q000502:physiology; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D016503:Drug Delivery Systems / Q000379:methods / Q000639:trends; D004358:Drug Therapy / Q000379:methods* / Q000639:trends*; D018380:Hematopoietic Stem Cell Transplantation / Q000639:trends; D006801:Humans; D009995:Osmosis / Q000187:drug effects / Q000502:physiology; D018579:Patient Selection
D000970:Antineoplastic Agents