title: Systemic BCNU enhances the efficacy of local delivery of a topoisomerase I inhibitor against malignant glioma.
abstract: OBJECTIVE
  To investigate the ability of systemically delivered BCNU to enhance the activity of either systemically delivered irinotecan (CPT-11) or locally delivered camptothecin from a biodegradable polymer for treatment of an intracranial 9L gliosarcoma.
  
  
  METHODS
  We used a single systemic dose of BCNU on treatment day 1 in combination with systemic doses of CPT-11 on treatment days 1-5 and 8-12 against an intracranial rat 9L gliosarcoma model implanted into female Fischer 344 rats. We also used the same systemic dose of BCNU given on treatment day 1, followed by a local dose of a 20% loaded camptothecin biodegradable polymer implanted on the same day.
  
  
  RESULTS
  Two doses of CPT-11 (10 and 60 mg/kg) were delivered systemically against intracranial 9L. Neither dose showed an increase in survival compared to controls ( P>0.2 for 10 mg/kg and P=0.17 for 60 mg/kg). Systemic delivery of CPT-11 (10 mg/kg per day) in combination with systemic BCNU (15 mg/kg) did not show a significant effect on survival compared to systemic BCNU alone ( P>0.2), even at the maximally tolerated systemic dose of CPT-11 (60 mg/kg per day; P=0.06). The combination of systemic BCNU (15 mg/kg) and intracranial delivery of camptothecin (20% loaded polymer), however, significantly extended survival compared to systemic BCNU alone ( P<0.001) and compared to intracranial delivery of camptothecin alone ( P=0.01).
  
  
  CONCLUSIONS
  In a 9L gliosarcoma model, systemic delivery of CPT-11 showed no benefit in survival when delivered alone or in combination with systemic BCNU, because CPT-11 is unable to cross the blood-brain barrier in cytotoxic levels. When cytotoxic levels of a topoisomerase I inhibitor are delivered directly to the brain tumor via a biodegradable polymer, however, the systemic delivery of the alkylating agent BCNU significantly enhances the antitumor effects of camptothecin in a 9L gliosarcoma model.
authors.affiliation: Department of Neurological Surgery, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: Phillip B
authors.initials: PB
authors.lastname: Storm
authors.forename: Violette M
authors.initials: VM
authors.lastname: Renard
authors.forename: John L
authors.initials: JL
authors.lastname: Moriarity
authors.forename: Betty
authors.initials: B
authors.lastname: Tyler
authors.forename: Robb E
authors.initials: RE
authors.lastname: Wilentz
authors.forename: Henry
authors.initials: H
authors.lastname: Brem
authors.forename: Jon D
authors.initials: JD
authors.lastname: Weingart
mesh_terms: D000818:Animals; D001932:Brain Neoplasms / Q000378:metabolism*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics*; D002330:Carmustine / Q000494:pharmacology*; D045744:Cell Line, Tumor; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000378:metabolism; D005260:Female; D018316:Gliosarcoma / Q000378:metabolism*; D000077146:Irinotecan; D009368:Neoplasm Transplantation; D051381:Rats; D011916:Rats, Inbred F344; D059004:Topoisomerase I Inhibitors
chemical_list: D004791:Enzyme Inhibitors; D059004:Topoisomerase I Inhibitors; D000077146:Irinotecan; D002330:Carmustine; D002166:Camptothecin