title: Pharmacotherapy for primary CNS lymphoma: progress beyond methotrexate?
abstract: Studies conducted in the 1990s have established that high-dose methotrexate-based chemotherapy added to whole-brain radiotherapy improves survival in primary CNS lymphoma (PCNSL). However, radiotherapy-related delayed neurotoxicity has emerged as a serious complication of chemo-radiotherapy, particularly in the elderly. Unfortunately, omitting radiotherapy results in decreased progression-free survival, and therefore establishing more effective chemotherapy regimens is necessary in order to improve the number of long-term remissions. Recent studies have suggested that a combination of drugs is superior to single-agent methotrexate, but the optimal chemotherapy combination and the role of alternative consolidation treatments such as reduced-dose radiotherapy and high-dose chemotherapy with stem cell rescue remain to be defined. In this article, we review the multiple chemotherapy options reported in newly diagnosed and in progressive/refractory PCNSL, including recently reported and ongoing clinical trials, as well as future perspectives.
authors.affiliation: Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Jerome J
authors.initials: JJ
authors.lastname: Graber
authors.forename: Antonio
authors.initials: A
authors.lastname: Omuro
mesh_terms: D016543:Central Nervous System Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy; D004358:Drug Therapy / Q000379:methods / Q000639:trends*; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000532:radiotherapy; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D033581:Stem Cell Transplantation / Q000379:methods
chemical_list: D008727:Methotrexate