The role of chemotherapy in the treatment of malignant astrocytomas.
Malignant astrocytomas are aggressive neoplasms with a dismal prognosis despite optimal treatment. Maximal resective surgery is traditionally complemented by radiation therapy. Chemotherapy is now used on patients as initial therapy when their functional status is congruent with further treatment. The classic agents used are nitrosoureas, but temozolomide has taken the front seat recently, with recent data demonstrating increased survival when this agent is used concurrently with radiation therapy in newly diagnosed glioblastoma patients. A new class of agents, refered to as biological modifiers, are increasingly used in clinical trials in an effort to affect the intrinsic biologic aberrations harboured by tumor cells. These drugs comprise differentiation agents, anti-angiogenic agents, matrix-metalloproteinase inhibitors and signal transduction inhibitors, among others. This article reviews the standard cytotoxic agents that have been used to treat malignant astrocytomas, and the different combination regimens offering promise. In addition, recent advances with biological modifiers are also discussed.
Mathieu
David
D
Division of Neurosurgery/Neuro-Oncology, Department of Surgery, Sherbrooke University and Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.
Fortin
David
D
D000970:Antineoplastic Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D018906:Antineoplastic Agents, Alkylating / Q000494:pharmacology / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology / Q000592:standards / Q000627:therapeutic use; D001254:Astrocytoma / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy / Q000592:standards / Q000639:trends; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D004358:Drug Therapy / Q000592:standards* / Q000639:trends*; D006801:Humans; D007155:Immunologic Factors / Q000494:pharmacology / Q000627:therapeutic use; D009607:Nitrosourea Compounds / Q000494:pharmacology / Q000627:therapeutic use; D000077204:Temozolomide
D000970:Antineoplastic Agents; D018906:Antineoplastic Agents, Alkylating; D007155:Immunologic Factors; D009607:Nitrosourea Compounds; D003606:Dacarbazine; D000077204:Temozolomide