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Saito A, Kitayama J, Nagai R, Aizawa K. Anatomical Targeting of Anticancer Drugs to Solid Tumors Using Specific Administration Routes: Review. Pharmaceutics 2023; 15:1664. [PMID: 37376112 DOI: 10.3390/pharmaceutics15061664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
Despite remarkable recent progress in developing anti-cancer agents, outcomes of patients with solid tumors remain unsatisfactory. In general, anti-cancer drugs are systemically administered through peripheral veins and delivered throughout the body. The major problem with systemic chemotherapy is insufficient uptake of intravenous (IV) drugs by targeted tumor tissue. Although dose escalation and treatment intensification have been attempted in order to increase regional concentrations of anti-tumor drugs, these approaches have produced only marginal benefits in terms of patient outcomes, while often damaging healthy organs. To overcome this problem, local administration of anti-cancer agents can yield markedly higher drug concentrations in tumor tissue with less systemic toxicity. This strategy is most commonly used for liver and brain tumors, as well as pleural or peritoneal malignancies. Although the concept is theoretically reasonable, survival benefits are still limited. This review summarizes clinical results and problems and discusses future directions of regional cancer therapy with local administration of chemotherapeutants.
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Affiliation(s)
- Akira Saito
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0431, Japan
| | - Joji Kitayama
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0431, Japan
- Division of Translational Research, Clinical Research Center, Jichi Medical University Hospital, Tochigi, Tochigi 329-0498, Japan
| | - Ryozo Nagai
- Department of Medicine, School of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Kenichi Aizawa
- Division of Translational Research, Clinical Research Center, Jichi Medical University Hospital, Tochigi, Tochigi 329-0498, Japan
- Division of Clinical Pharmacology, Department of Pharmacology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
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Cheng X, Li F, Liang L. Boron Neutron Capture Therapy: Clinical Application and Research Progress. Curr Oncol 2022; 29:7868-7886. [PMID: 36290899 PMCID: PMC9601095 DOI: 10.3390/curroncol29100622] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
Boron neutron capture therapy (BNCT) is a binary modality that is used to treat a variety of malignancies, using neutrons to irradiate boron-10 (10B) nuclei that have entered tumor cells to produce highly linear energy transfer (LET) alpha particles and recoil 7Li nuclei (10B [n, α] 7Li). Therefore, the most important part in BNCT is to selectively deliver a large number of 10B to tumor cells and only a small amount to normal tissue. So far, BNCT has been used in more than 2000 cases worldwide, and the efficacy of BNCT in the treatment of head and neck cancer, malignant meningioma, melanoma and hepatocellular carcinoma has been confirmed. We collected and collated clinical studies of second-generation boron delivery agents. The combination of different drugs, the mode of administration, and the combination of multiple treatments have an important impact on patient survival. We summarized the critical issues that must be addressed, with the hope that the next generation of boron delivery agents will overcome these challenges.
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Affiliation(s)
- Xiang Cheng
- Oncology Department, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei Economic and Technological Development Zone, Hefei 230601, China
| | - Fanfan Li
- Oncology Department, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei Economic and Technological Development Zone, Hefei 230601, China
- Correspondence: (F.L.); (L.L.); Tel.: +86-13855137365 (F.L.); +86-15905602477 (L.L.)
| | - Lizhen Liang
- Hefei Comprehensive National Science Center, Institute of Energy, Building 9, Binhu Excellence City Phase I, 16 Huayuan Avenue, Baohe District, Hefei 230031, China
- Correspondence: (F.L.); (L.L.); Tel.: +86-13855137365 (F.L.); +86-15905602477 (L.L.)
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Guigou C, Lalande A, Millot N, Belharet K, Bozorg Grayeli A. Use of Super Paramagnetic Iron Oxide Nanoparticles as Drug Carriers in Brain and Ear: State of the Art and Challenges. Brain Sci 2021; 11:358. [PMID: 33799690 PMCID: PMC7998448 DOI: 10.3390/brainsci11030358] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 12/16/2022] Open
Abstract
Drug delivery and distribution in the central nervous system (CNS) and the inner ear represent a challenge for the medical and scientific world, especially because of the blood-brain and the blood-perilymph barriers. Solutions are being studied to circumvent or to facilitate drug diffusion across these structures. Using superparamagnetic iron oxide nanoparticles (SPIONs), which can be coated to change their properties and ensure biocompatibility, represents a promising tool as a drug carrier. They can act as nanocarriers and can be driven with precision by magnetic forces. The aim of this study was to systematically review the use of SPIONs in the CNS and the inner ear. A systematic PubMed search between 1999 and 2019 yielded 97 studies. In this review, we describe the applications of the SPIONS, their design, their administration, their pharmacokinetic, their toxicity and the methods used for targeted delivery of drugs into the ear and the CNS.
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Affiliation(s)
- Caroline Guigou
- Department of Otolaryngology-Head and Neck Surgery, Dijon University Hospital, 21000 Dijon, France;
- ImVia Laboratory, EA 7535, Université Bourgogne Franche-Comté, 21079 Dijon, France;
| | - Alain Lalande
- ImVia Laboratory, EA 7535, Université Bourgogne Franche-Comté, 21079 Dijon, France;
| | - Nadine Millot
- Laboratoire Interdisciplinaire Carnot de Bourgogne, UMR 6303, CNRS, Université Bourgogne Franche-Comté, BP 47870, 21078 Dijon, France;
| | - Karim Belharet
- Laboratoire PRISME, JUNIA Campus Centre, 36000 Châteauroux, France;
| | - Alexis Bozorg Grayeli
- Department of Otolaryngology-Head and Neck Surgery, Dijon University Hospital, 21000 Dijon, France;
- ImVia Laboratory, EA 7535, Université Bourgogne Franche-Comté, 21079 Dijon, France;
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Guyon J, Chapouly C, Andrique L, Bikfalvi A, Daubon T. The Normal and Brain Tumor Vasculature: Morphological and Functional Characteristics and Therapeutic Targeting. Front Physiol 2021; 12:622615. [PMID: 33746770 PMCID: PMC7973205 DOI: 10.3389/fphys.2021.622615] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/25/2021] [Indexed: 12/20/2022] Open
Abstract
Glioblastoma is among the most common tumor of the central nervous system in adults. Overall survival has not significantly improved over the last decade, even with optimizing standard therapeutic care including extent of resection and radio- and chemotherapy. In this article, we review features of the brain vasculature found in healthy cerebral tissue and in glioblastoma. Brain vessels are of various sizes and composed of several vascular cell types. Non-vascular cells such as astrocytes or microglia also interact with the vasculature and play important roles. We also discuss in vitro engineered artificial blood vessels which may represent useful models for better understanding the tumor-vessel interaction. Finally, we summarize results from clinical trials with anti-angiogenic therapy alone or in combination, and discuss the value of these approaches for targeting glioblastoma.
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Affiliation(s)
- Joris Guyon
- INSERM, LAMC, U1029, University Bordeaux, Pessac, France
| | - Candice Chapouly
- INSERM, Biology of Cardiovascular Diseases, U1034, University Bordeaux, Pessac, France
| | - Laetitia Andrique
- INSERM, LAMC, U1029, University Bordeaux, Pessac, France.,VoxCell 3D Plateform, UMS TBMcore 3427, Bordeaux, France
| | | | - Thomas Daubon
- University Bordeaux, CNRS, IBGC, UMR 5095, Bordeaux, France
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Triarico S, Maurizi P, Mastrangelo S, Attinà G, Capozza MA, Ruggiero A. Improving the Brain Delivery of Chemotherapeutic Drugs in Childhood Brain Tumors. Cancers (Basel) 2019; 11:cancers11060824. [PMID: 31200562 PMCID: PMC6627959 DOI: 10.3390/cancers11060824] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 05/27/2019] [Accepted: 06/11/2019] [Indexed: 12/20/2022] Open
Abstract
The central nervous system (CNS) may be considered as a sanctuary site, protected from systemic chemotherapy by the meninges, the cerebrospinal fluid (CSF) and the blood-brain barrier (BBB). Consequently, parenchymal and CSF exposure of most antineoplastic agents following intravenous (IV) administration is lower than systemic exposure. In this review, we describe the different strategies developed to improve delivery of antineoplastic agents into the brain in primary and metastatic CNS tumors. We observed that several methods, such as BBB disruption (BBBD), intra-arterial (IA) and intracavitary chemotherapy, are not routinely used because of their invasiveness and potentially serious adverse effects. Conversely, intrathecal (IT) chemotherapy has been safely and widely practiced in the treatment of pediatric primary and metastatic tumors, replacing the neurotoxic cranial irradiation for the treatment of childhood lymphoma and acute lymphoblastic leukemia (ALL). IT chemotherapy may be achieved through lumbar puncture (LP) or across the Ommaya intraventricular reservoir, which are both described in this review. Additionally, we overviewed pharmacokinetics and toxic aspects of the main IT antineoplastic drugs employed for primary or metastatic childhood CNS tumors (such as methotrexate, cytosine arabinoside, hydrocortisone), with a concise focus on new and less used IT antineoplastic agents.
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Affiliation(s)
- Silvia Triarico
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy.
| | - Palma Maurizi
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy.
| | - Stefano Mastrangelo
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy.
| | - Giorgio Attinà
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy.
| | - Michele Antonio Capozza
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy.
| | - Antonio Ruggiero
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168 Rome, Italy.
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The usefulness of fibrin glue as a support in the dissection of malignant cystic brain tumors. Neurochirurgie 2018; 64:57-62. [PMID: 29429648 DOI: 10.1016/j.neuchi.2017.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/08/2017] [Accepted: 09/11/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND If the complete microsurgical resection of a brain tumor is a logical oncologic goal, the surgical strategy for the cystic component remains controversial secondary to the risk of morbidity. The objective of this study was to analyze the interest of using fibrin glue in the resection of malignant cystic brain tumors (MCBT). METHODS Seven patients (median: 60-years-old (range [52-72]/sex ratio M/F: 2.5) were analyzed prospectively in the Neurosurgery Department at Strasbourg University Hospital, from October 2014 to November 2016. The surgical technique consisted of injecting fibrin glue into the tumor cyst after partial drainage. After the solidification of the glue, the cysts walls were removal by following the dissection plan around the fibrin glue. The primary objective was to evaluate the quality of surgical resection on brain MRI scans postoperatively with the use of ITK-SNAP software for precise measurements of tumor volume. RESULTS Four metastases and 3 glial lesions were operated on with this technique. An average reduction in cystic volume of 64.6% (P=0.016) and 82.1% (P=0.016) for contrast enhancement volume were observed. If two cases (#2 and #7) were excluded, the average contrast enhancement reduction was respectively 94% and 72% for the cystic volume. In addition, there were no complications, tumor recurrence or difference between gliomas and metastases and the Karnofsky score increased by at least 10% in all patients. CONCLUSION This procedure allowed to extend the resection to the cystic component of MCBT without increasing the risk of morbidity related to injury on the underlying parenchyma.
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Srikandarajah N, Patel A, Lee MK, Brodbelt A. Indications for intracranial reservoirs: A six-year study. Br J Neurosurg 2013; 28:475-7. [DOI: 10.3109/02688697.2013.854314] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mascitelli J, De Los Reyes K, Steinberger J, Zou H. Lack of functionality and need for revision of an Ommaya reservoir placed into a cavum septum pellucidum. J Neurosurg 2013; 118:502-4. [DOI: 10.3171/2012.10.jns12818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ommaya reservoirs are routinely placed for the administration of intrathecal chemotherapy or antibiotics. There is scant literature that addresses the functionality of an Ommaya catheter placed exclusively within a cavum septum pellucidum (CSP). In this case, the authors placed an Ommaya reservoir in a 30-year-old man with Burkitt lymphoma in the CNS for intrathecal chemotherapy. The catheter tip was placed within a large CSP. The authors demonstrated failure of the system by injecting contrast agent into the reservoir and obtaining immediate and delayed CT scans that failed to demonstrate contrast dissemination into the ventricular system. An Ommaya reservoir placed exclusively within a CSP is potentially not functional, and can be dangerous if used for intrathecal drug therapy.
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9
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Strategy for effective brain drug delivery. Eur J Pharm Sci 2010; 40:385-403. [DOI: 10.1016/j.ejps.2010.05.003] [Citation(s) in RCA: 256] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 04/15/2010] [Accepted: 05/10/2010] [Indexed: 12/20/2022]
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Mir O, Ropert S, Alexandre J, Lemare F, Goldwasser F. High-dose intrathecal trastuzumab for leptomeningeal metastases secondary to HER-2 overexpressing breast cancer. Ann Oncol 2008; 19:1978-80. [PMID: 18845838 DOI: 10.1093/annonc/mdn654] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Arnhold S, Klein H, Klinz FJ, Absenger Y, Schmidt A, Schinköthe T, Brixius K, Kozlowski J, Desai B, Bloch W, Addicks K. Human bone marrow stroma cells display certain neural characteristics and integrate in the subventricular compartment after injection into the liquor system. Eur J Cell Biol 2006; 85:551-65. [PMID: 16647786 DOI: 10.1016/j.ejcb.2006.01.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2005] [Revised: 01/11/2006] [Accepted: 01/11/2006] [Indexed: 11/15/2022] Open
Abstract
Because the neural differentiation capacity of bone marrow stromal cells (BMSCs) is still a matter of controversial debate, we performed a thorough investigation into the differentiation capacity of human BMSCs and examined their therapeutic potency. BMSCs were isolated from the femur and kept in cell cultures with various cultivation protocols being applied. In standard culture conditions using a fetal calf serum-enriched medium, while not exhibiting a neural phenotype, the majority of cells expressed a variety of neuronal marker proteins as well as the astrocyte marker GFAP. Only a minority of stem cells expressed nestin, a marker for neural precursor cells. Cultivation in serum-free medium supplemented with specific growth factors resulted in a markedly higher percentage of nestin-positive cells. To establish the therapeutic potency of bone marrow-derived cells, the synthesis of neurotrophic factors such as NGF, BDNF and GDNF was analyzed under non-stimulating standard culture conditions as well as after a neural selection procedure. The therapeutic potency of BMSCs was further examined with regard to their migratory potential in vitro and after transplantation in vivo. After stereotactic engraftment into the lateral ventricle of adult rats, mesenchymal stem cells were seen to adhere to the ependymocytes and cells of the choroids plexus. Afterwards grafted cells passed through the ependymal barrier, locating in the subventricular space. Their BMSCs took up a close host graft interaction without any degenerative influence on the host cells. Furthermore, there was morphological as well as immunohistochemical evidence for a transdifferentiation within the host tissue. In addition, BMSCs could be efficiently transduced using a third-generation adenoviral vector, indicating their potential feasibility for a gene-therapeutic option.
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Affiliation(s)
- Stefan Arnhold
- Department of Anatomy I, University of Cologne, Josef-Stelzmannstr. 9, D-50931 Köln, Germany.
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Sherman PM, Aygun N. Development of a cavum septi pellucidi after Ommaya reservoir placement: report of an unusual complication. Acta Neurochir (Wien) 2006; 148:359-62; discussion 362. [PMID: 16283105 DOI: 10.1007/s00701-005-0652-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Accepted: 09/21/2005] [Indexed: 11/30/2022]
Abstract
Objective and importance. We present a complication of Ommaya reservoir placement that has not been previously reported. Following injection of a seemingly appropriately placed catheter, the patient developed seizures. Imaging studies showed the development and resolution of a cavum septi pellucidi. This case illustrates that the septum pellucidum is made of two layers and that a potential space exists between these layers. Caution is recommended when injecting a single-hole ventricular catheter if the tip is against the septum pellucidum.
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Affiliation(s)
- P M Sherman
- Johns Hopkins Medical Institution, Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Neuroradiology, Baltimore, MD, USA.
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Sakurai Y, Ono K, Miyatake SI, Maruhashi A. Improvement effect on the depth-dose distribution by CSF drainage and air infusion of a tumour-removed cavity in boron neutron capture therapy for malignant brain tumours. Phys Med Biol 2006; 51:1173-83. [PMID: 16481686 DOI: 10.1088/0031-9155/51/5/009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Boron neutron capture therapy (BNCT) without craniotomy for malignant brain tumours was started using an epi-thermal neutron beam at the Kyoto University Reactor in June 2002. We have tried some techniques to overcome the treatable-depth limit in BNCT. One of the effective techniques is void formation utilizing a tumour-removed cavity. The tumorous part is removed by craniotomy about 1 week before a BNCT treatment in our protocol. Just before the BNCT irradiation, the cerebro-spinal fluid (CSF) in the tumour-removed cavity is drained out, air is infused to the cavity and then the void is made. This void improves the neutron penetration, and the thermal neutron flux at depth increases. The phantom experiments and survey simulations modelling the CSF drainage and air infusion of the tumour-removed cavity were performed for the size and shape of the void. The advantage of the CSF drainage and air infusion is confirmed for the improvement in the depth-dose distribution. From the parametric surveys, it was confirmed that the cavity volume had good correlation with the improvement effect, and the larger effect was expected as the cavity volume was larger.
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Affiliation(s)
- Yoshinori Sakurai
- Kyoto University Research Reactor Institute, Asashironishi 2-1010, Kumatori-cho, Sennan-gun, Osaka 590-0494, Japan.
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Huynh GH, Deen DF, Szoka FC. Barriers to carrier mediated drug and gene delivery to brain tumors. J Control Release 2006; 110:236-259. [PMID: 16318895 DOI: 10.1016/j.jconrel.2005.09.053] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Accepted: 09/29/2005] [Indexed: 01/18/2023]
Abstract
Brain tumor patients face a poor prognosis despite significant advances in tumor imaging, neurosurgery and radiation therapy. Potent chemotherapeutic drugs fail when used to treat brain tumors because biochemical and physiological barriers limit drug delivery into the brain. In the past decade a number of strategies have been introduced to increase drug delivery into the brain parenchyma. In particular, direct drug administration into the brain tumor has shown promising results in both animal models and clinical trials. This technique is well suited for the delivery of liposome and polymer drug carriers, which have the potential to provide a sustained level of drug and to reach cellular targets with improved specificity. We will discuss the current approaches that have been used to increase drug delivery into the brain parenchyma in the context of fluid and solute transport into, through and from the brain, with a focus on liposome and polymer drug carriers.
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Affiliation(s)
- Grace H Huynh
- Joint Graduate Group in Bioengineering, University of California at San Francisco and Berkeley San Francisco, CA 94143-0446, United States
| | - Dennis F Deen
- Brain Tumor Research Center of the Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA 94143-0520, United States
| | - Francis C Szoka
- Joint Graduate Group in Bioengineering, University of California at San Francisco and Berkeley San Francisco, CA 94143-0446, United States; Departments of Pharmaceutical Chemistry and Biopharmaceutical Sciences, University of California at San Francisco, San Francisco, CA 94143-0446, United States.
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Abstract
OBJECTIVE Present a revised neurosurgical technique for insertion of the Ommaya reservoir that we have routinely utilized and found to have fewer complications that the standard approach. EXPERIMENTAL DESIGN Randomized retrospective study of 20 patients who underwent insertion of Ommaya reservoir with the preassembled technique. SETTING Major university hospital. PATIENTS OR PARTICIPANTS Twenty patients who underwent Ommaya reservoir placement within the last 5 years were randomly selected for chart and computed tomography review. INTERVENTIONS A new preassembled technique for Ommaya reservoir placement was utilized in all 20 patients. MEASURES Retrospective review of the patient records and computed tomography scans of 20 patients undergoing Ommaya placement were performed to assess ventricular catheter placement and any postoperative complications. RESULTS In all 20 patients, we had consistent ipsilateral right frontal horn placement of ventricular catheter and had no postoperative morbidities, reoperations for ventricular catheter positioning or mortalities. CONCLUSIONS This technique reduces overall operative time, decreases risk for intraoperative infection, and poor ventricular catheter placement by eliminating the manipulation step of connecting the reservoir to the catheter in vivo.
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Affiliation(s)
- Rob D Dickerman
- Department of Neurosurgery, Plano Presbyterian Hospital-Texas Back Institute, Texas 75093, USA.
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16
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Voges J, Lehrke R, Kim DG, Lucas C, Schröder R, Sturm V, Stricker H. Tissue reactions after long-term intracerebral implantation of three different types of biodegradable polylactide rods in the rat. JOURNAL OF EXPERIMENTAL THERAPEUTICS AND ONCOLOGY 2002; 2:70-6. [PMID: 12415622 DOI: 10.1046/j.1359-4117.2002.01012.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate acute and late tissue reactions following intracerebral implantation of three different biodegradable DL-polylactids: Resomer R104 + R203 (1 + 1) (SU48), Resomer R203 (SU49), and DL-polylactid-co-trimethylencarbonat (SU50). METHODS Polylactide (PL) rods and small pieces of silicon (control) were stereotactically implanted in the forebrain of 60 Wistar rats. Twenty-eight, 70, and 112 days after implantation, five animals of each group (SU48, SU49, SU50, control) were sacrificed. Tissue slices of the paraffin-embedded brains were stained with hematoxylin and eosin (HE) for histological evaluation. RESULTS Independent from the investigated sample, the site of implantation was visible on the brain sections as a clearly demarcated tissue defect surrounded by minimal inflammatory cellular reactions. Although not significant, implantation of SU50 caused the most distinct invasion of foamy macrophages. Despite SU48, which 112 days after implantation was surrounded by a thin layer of predominantly gliotic fibers, demarcation of surrounding brain tissue was of minor degree. DISCUSSION The PL rods investigated in this study caused no significant early and late tissue alterations. Both the good biocompatibility of these samples and a high flexibility with regard to degradation time and release kinetics allow either long protracted drug release or short-term application of substances.
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Affiliation(s)
- Jürgen Voges
- Department of Stereotactic and Functional Neurosurgery, University of Cologne, Josef-Stelzmann-Strasse 9, D-50931 Köln, Germany.
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Ruggiero A, Conter V, Milani M, Biagi E, Lazzareschi I, Sparano P, Riccardi R. Intrathecal chemotherapy with antineoplastic agents in children. Paediatr Drugs 2001; 3:237-46. [PMID: 11354696 DOI: 10.2165/00128072-200103040-00001] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Intrathecal chemotherapy with antineoplastic agents is mainly utilised in children with leukaemia and lymphoma, and in selected brain tumours. In these diseases, intrathecal use is restricted to methotrexate (MTX), cytosine arabinoside (Ara-C) and corticosteroids. A number of other agents are, at the present time, under evaluation. Intrathecal MTX administered sequentially with systemic high dose MTX infusion prolongs therapeutic cerebral spinal fluid (CSF) levels of the drug. Prolonged therapeutic CSF levels can also be achieved by giving repeated small intrathecal doses of MTX over an extended period in selected patients, with an implanted Ommaya reservoir. In the CSF, the metabolic inactivation of Ara-C is significantly lower than in plasma with a CSF clearance similar to the rate of CSF bulk flow. A slow-release formulation of Ara-C may be given intrathecally, resulting in a prolonged cytotoxic concentration in the CSF. CNS relapse and neurotoxicity in patients with acute lymphoblastic leukaemia, especially younger children, may be reduced by using age-related dosing of intrathecal MTX and Ara-C. Hydrocortisone is used in combination with MTX and Ara-C for so-called 'triple intrathecal chemotherapy' in the treatment of meningeal leukaemia. Intrathecal thiotepa does not appear to be advantageous over systemic administration in patients with brain and meningeal leukaemia. Monoclonal antibodies, reactive with tumour-associated antigens, can be used as delivery systems for chemotherapeutic agents and radionuclides. However, the development of this new approach is currently under evaluation in larger clinical studies. Neurological adverse effects may be expected with intrathecal chemotherapy and are increased by high dose systemic therapy, concomitant cranial radiotherapy or meningeal infiltration by neoplastic cells. Inadvertant intrathecal administration of antineoplastic agents that are indicated for systemic administration only, is dangerous and may result in a fatal outcome.
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Affiliation(s)
- A Ruggiero
- Division of Paediatric Oncology, Catholic University, Rome, Italy
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18
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Abstract
A dysfunctional central nervous system (CNS) resulting from neurological disorders and diseases impacts all of humanity. The outcome presents a staggering health care issue with a tremendous potential for developing interventive therapies. The delivery of therapeutic molecules to the CNS has been hampered by the presence of the blood-brain barrier (BBB). To circumvent this barrier, putative therapeutic molecules have been delivered to the CNS by such methods as pumps/osmotic pumps, osmotic opening of the BBB, sustained polymer release systems and cell delivery via site-specific transplantation of cells. This review presents an overview of some of the CNS delivery technologies with special emphasis on transplantation of cells with and without the use of polymer encapsulation technology.
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Affiliation(s)
- M S Shoichet
- Department of Chemical Engineering and Applied Chemistry, Institute of Biomaterials and Biomedical Engineering, University of Toronto, 200 College Street, Toronto, M55 3E5, Ontario, Canada.
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Moser AM, Adamson PC, Gillespie AJ, Poplack DG, Balis FM. Intraventricular concentration times time (C x T) methotrexate and cytarabine for patients with recurrent meningeal leukemia and lymphoma. Cancer 1999; 85:511-6. [PMID: 10023723 DOI: 10.1002/(sici)1097-0142(19990115)85:2<511::aid-cncr33>3.0.co;2-h] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Intraventricular chemotherapy results in more uniform drug distribution within the subarachnoid space and allows for more flexible drug administration schedules. The authors report their experience with an intraventricular concentration times time (C x T) chemotherapy regimen for recurrent meningeal leukemia and lymphoma. METHODS Twenty-one patients (median age, 11.6 years) received C x T therapy for meningeal acute lymphoblastic leukemia (n = 18), Burkitt's lymphoma (n = 2), or undifferentiated leukemia (n = 1). Prior therapy included standard intrathecal (IT) methotrexate and cytarabine, cranial or craniospinal radiation (median, 24 Gy), and 0-5 experimental treatment modalities. C x T induction therapy consisted of 2 mg of intraventricular methotrexate administered daily for 3 days every 10 days, for 4 courses. Patients were then consolidated with 4 courses of alternating intraventricular cytarabine (15 mg/day) or methotrexate (2 mg/day) daily for 3 days every 2 weeks (2 courses of methotrexate and 2 courses of cytarabine). Maintenance therapy consisted of alternating monthly courses of C x T methotrexate or cytarabine. RESULTS Ninety-three percent of patients (14 of 15) who were evaluable for response achieved a complete remission in a median of 10 days (range, 2-40 days). Median remission duration was 15 months. Fourteen patients died of recurrent disease or systemic treatment-related complications; 2 patients are alive, off treatment, and in continuous complete remission for 59+ and 89+ months; 1 patient experienced a meningeal relapse at 24 months on C x T therapy but was reinduced with the C x T regimen, received craniospinal radiation, and is in remission at 142+ months; and 3 are alive with disease at 32+, 72+, and 81+ months. One patient was lost to follow-up. CONCLUSIONS This regimen appears to be an effective and well-tolerated palliative treatment for patients with recurrent meningeal leukemia and lymphoma.
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Affiliation(s)
- A M Moser
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland 20892, USA
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Koole LH, Kruft MA, Aldenhoff YB, van 't Oost NE, van Kroonenburgh MJ, van der Veen FH. Sustained local drug delivery from a radiopaque implanted reservoir. Nat Biotechnol 1998; 16:172-6. [PMID: 9487525 DOI: 10.1038/nbt0298-172] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A new polymeric biomaterial that contains covalently bound iodine, and is therefore radiopaque, was used to construct a sustained local drug-delivery device. A polymeric wall was designed to be porous (i.e., passage of low-molecular-weight molecules across the wall is possible), self-healing, and biocompatible. Once implanted, the sphere cavity can be filled and refilled with a concentrated solution of a (cytostatic) drug, which is subsequently released by slow diffusion into the tissue region surrounding the sphere. This principle of sustained local drug delivery is shown by a series of in vitro experiments on the release of 5-fluorouracil, and in vivo animal experiments, using x-ray fluoroscopic and scintigraphic techniques.
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Affiliation(s)
- L H Koole
- Centre for Biomaterials Research, University of Maastricht, The Netherlands.
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Giovanini MA, Mickle JP. Long-term access to cystic brain stem lesions using the Ommaya reservoir: technical case report. Neurosurgery 1996; 39:404-7; discussion 407-8. [PMID: 8832683 DOI: 10.1097/00006123-199608000-00039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE AND IMPORTANCE Unresectable cystic brain stem lesions are often responsible for neurological dysfunction. Stereotactic aspiration of such lesions can lead to clinical improvement, but cyst recurrence is common and multiple aspirations may be necessary. CLINICAL PRESENTATION Three children with unresectable cystic brain stem lesions were treated at the University of Florida. Two patients initially underwent stereotactic biopsy and cystic aspiration, both improving after cystic decompression. Both patients returned 3 months later with symptomatic cyst recurrences requiring further intervention. Six years after surgical resection of a posterior fossa medulloblastoma, the third patient presented with a dorsal midbrain cyst. INTERVENTION All three patients had catheters placed into the cyst cavities under stereotactic guidance. A subcutaneous Ommaya reservoir was attached to the existing catheter. In the event of symptomatic cyst recurrence, the Ommaya reservoir can be tapped in an outpatient setting. CONCLUSION Cystic decompression resulted in clinical improvement in all three children. Multiple aspirations were necessary in two patients for symptomatic cyst recurrences. The Ommaya reservoir allows for cyst aspiration in an outpatient setting and avoids multiple stereotactic manipulations. This system may also be used to instill radioisotopes or it may be converted to a cyst-peritoneal shunt if multiple aspirations fail to achieve cystic control.
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Affiliation(s)
- M A Giovanini
- Department of Neurosurgery, University of Florida, Gainesville, USA
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Abstract
OBJECTIVE To provide an overview of access devices used to treat cancers through the arterial, peritoneal, and intraventricular body systems. CONCLUSIONS Short-term and long-term devices have been developed over the last 35 years for cancer treatment. Although less amenable to standard methods of therapy, the various access devices available to access the arterial, peritoneal, and intraventricular systems have provided a safe and reliable means for drug therapy. Access devices assist in delivering high concentrations of drugs directly to the center of the tumor. Complications and toxicities are inherent with these devices from the drug therapy as well as the device. Nursing assessment can provide early identification of potential problems and implementation of appropriate interventions. IMPLICATIONS FOR NURSING PRACTICE As the availability of these devices increases, so must the nurse's knowledge base to provide optimal safe care. Oncology nurses are challenged to know the differences between the devices, the device of choice for the individual patient, insertion procedures, and maintenance protocols.
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MESH Headings
- Catheters, Indwelling/adverse effects
- Catheters, Indwelling/supply & distribution
- Chemotherapy, Cancer, Regional Perfusion
- Humans
- Infusions, Intra-Arterial/adverse effects
- Infusions, Intra-Arterial/instrumentation
- Infusions, Intra-Arterial/nursing
- Injections
- Injections, Intraperitoneal/adverse effects
- Injections, Intraperitoneal/instrumentation
- Injections, Intraperitoneal/nursing
- Injections, Intraventricular/adverse effects
- Injections, Intraventricular/instrumentation
- Injections, Intraventricular/nursing
- Neoplasms/drug therapy
- Neoplasms/nursing
- Nursing Assessment
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Affiliation(s)
- L Almadrones
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Affiliation(s)
- S L Berg
- Department of Pediatrics, Texas Children's Hospital, Houston, USA
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Catecholamine-Containing Biodegradable Microsphere Implants: An Overview of Experimental Studies in Dopamine-Lesioned Rats. ACTA ACUST UNITED AC 1995. [DOI: 10.1007/978-1-4757-9145-7_62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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McRae A, Ling EA, Hjorth S, Dahlström A, Mason D, Tice T. Catecholamine-containing biodegradable microsphere implants as a novel approach in the treatment of CNS neurodegenerative disease. A review of experimental studies in DA-lesioned rats. Mol Neurobiol 1994; 9:191-205. [PMID: 7888096 DOI: 10.1007/bf02816119] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Biodegradable controlled-release microsphere systems made with the biocompatible biodegradable polyester excipient poly(DL-lactide-co-glycolide) constitute an exciting new technology for drug delivery to the central nervous system (CNS). Implantable controlled-release microspheres containing dopamine (DA) or norepinephrine (NE) provide a novel means to compare DA- or NE -induced restitution of function in unilateral 6-hydroxydopamine lesioned rats. A suspension of 3 microL of DA- or NE-containing microspheres or empty microspheres was implanted in 2 sites of the DA denervated striatum of rats previously unilaterally lesioned with 6-hydroxydopamine. Contralateral-rotational behavior induced by apomorphine was used as an index of lesion success and, following implantation of the microspheres, also as an index of functional recovery. Interestingly, both DA- and NE-microsphere-implanted rats displayed a 30-50% reduction in the number of apomorphine-induced rotations up to 8 wk postimplantation. Rats implanted with empty microspheres did not demonstrate significant changes in contralateral rotational behavior. Behavioral studies following implantation of a mixture of DA and NE microspheres revealed an 80% decrease in the number of apomorphine induced rotations up to 4 wk. On conclusion of the studies, immunocytochemical examination revealed growth of DA and tyrosine hydroxylase immunoreactive fibers in the striatum of DA and NE microsphere-implanted rats. Functional behavior appeared to correlate with the degree of fiber growth. Preliminary electron microscopic studies showed signs of axonal sprouting in the vicinity of the implanted microspheres. No growth was noted in rats implanted with empty microspheres. This report reviews the abilities of both microencapsulated NE and DA to assure functional recovery and to promote DA fiber (re)growth in parkinsonian rats. This novel means to deliver these substances to the central nervous system could be of therapeutic usefulness in Parkinson's disease.
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Affiliation(s)
- A McRae
- University of Göteborg Department of Anatomy and Cell Biology, Sweden
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Donelli MG, Zucchetti M, D'Incalci M. Do anticancer agents reach the tumor target in the human brain? Cancer Chemother Pharmacol 1992; 30:251-60. [PMID: 1643692 DOI: 10.1007/bf00686291] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The development of effective chemotherapy for tumors of the central nervous system (CNS) is complicated in that the blood-brain barrier (BBB) hampers the penetration of most drugs into the brain and cerebrospinal fluid (CSF). This review summarizes the main reports on the distribution to CNS tumors and peritumoral normal brain of antitumor agents such as epipodophyllotoxins, cis-diamminedichloroplatinum(II), some nitrosoureas, bleomycin, vinblastine, and other clinically used antitumor agents as well as that of some experimental compounds with specific physicochemical properties. Drug levels were measured at surgical resection or in autopsy samples taken from patients who presented with different primary brain tumors or with brain metastases from extracerebral tumors. The observations made in each study were summarized in some detail, and the main points were then evaluated comparatively so as to highlight common aspects in the pharmacokinetic patterns of antitumor agents in human CNS tumors. Independently of their physicochemical properties, most antitumor agents appear to accumulate to a greater extent and to persist longer in intracerebral tumors than in the normal peritumoral brain. From in vitro cytotoxicity assays, it appears that epipodophyllotoxins, platinum compounds, bleomycin, and nitrosoureas reach potentially active therapeutic concentrations at the tumor target. However, all drugs have difficulty in reaching brain tissue adjacent to the tumor, as the intact BBB hampers their penetration. Plasma and CSF drug concentrations usually give little useful indication of the absolute quantity of drugs in brain tumors. To obtain a clear understanding of the CNS distribution of antitumor agents, one must determine whether the compound being measured is actually responsible for the observed activity and must consider the role of metabolites in the effect of the parent drug.
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Affiliation(s)
- M G Donelli
- Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
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Ike O, Shimizu Y, Ikada Y, Watanabe S, Natsume T, Wada R, Hyon SH, Hitomi S. Biodegradation and antitumour effect of adriamycin-containing poly(L-lactic acid) microspheres. Biomaterials 1991; 12:757-62. [PMID: 1799651 DOI: 10.1016/0142-9612(91)90026-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Adriamycin-containing poly (L-lactic acid) microspheres were prepared to develop a slow-releasing and long-acting adriamycin delivery system. An almost constant release of adriamycin from the adriamycin-containing poly(L-lactic acid) was achieved in Tris buffer and adriamycin disappeared within 20 d. Adriamycin was not detected in serum for up to 14 d, when the suspension of the adriamycin-containing poly(L-lactic acid) microspheres was injected into lung parenchyma, the femoral muscles of rabbits or the peritoneal cavity of mice. However, adriamycin remained in the rabbit muscles for up to 10 d under formation of scar tissue. When free adriamycin was added to P815 tumour cells in culture, the cell survival rate decreased with the exposure time. The treatment with the adriamycin-containing poly(L-lactic acid) microspheres showed a higher survival rate for mice bearing P815 tumour cells than with free adriamycin. In addition, the systemic side effects were insignificant when the adriamycin-containing poly(L-lactic acid) microspheres were given to mice instead of free adriamycin.
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Affiliation(s)
- O Ike
- Research Centre for Biomedical Engineering, Kyoto University, Japan
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Madrid Y, Langer LF, Brem H, Langer R. New directions in the delivery of drugs and other substances to the central nervous system. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 1991; 22:299-324. [PMID: 1958504 DOI: 10.1016/s1054-3589(08)60039-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Y Madrid
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge 02139
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Abstract
Great strides have been made in the chemotherapy of childhood ALL over the past three decades. Principles and concepts learned from early successes in treating this disease subsequently have been applied to the treatment of other pediatric cancers and adult malignancies. Because of the prominent role of chemotherapy in the treatment of ALL, a clear understanding of the clinical pharmacology of the antileukemic drugs is essential. This article reviews issues relating to the clinical pharmacology of the anticancer drugs that are commonly used in the treatment of acute lymphoblastic leukemia.
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Affiliation(s)
- F M Balis
- National Cancer Institute, Bethesda, Maryland
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Haaxma-Reiche H, Daenen S. Acute lymphoblastic leukemia in adults: results of intraventricular maintenance chemotherapy for central nervous system prophylaxis and treatment. EUROPEAN JOURNAL OF CANCER & CLINICAL ONCOLOGY 1988; 24:615-20. [PMID: 3164268 DOI: 10.1016/0277-5379(88)90289-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The results of intraventricular (i.vt.) chemotherapy in 36 cases of adult acute lymphoblastic leukemia (ALL) were analyzed to define a useful and reliable form of central nervous system (CNS) prophylaxis. Patients received methotrexate (MTX) via an Ommaya reservoir six times every 4 weeks. This was repeated when bone marrow relapse occurred. Intraventricular maintenance CNS prophylaxis during half a year appeared adequate, since primary CNS relapses were seen in only two patients (5.6%). These patients had failed to follow the prophylaxis schedule. The procedure was implemented and repeated relatively easily and did not lead to neurotoxic problems. The i.vt. route was also satisfactory for the treatment of initial and recurrent episodes of meningeal leukemia (ML). The therapy reduced morbidity caused by ML to a minimum.
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Affiliation(s)
- H Haaxma-Reiche
- Department of Neurology, University of Groningen, The Netherlands
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Stahl SM. Applications of new drug delivery technologies to Parkinson's disease and dopaminergic agents. JOURNAL OF NEURAL TRANSMISSION. SUPPLEMENTUM 1988; 27:123-32. [PMID: 3042910 DOI: 10.1007/978-3-7091-8954-2_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Recent advances in drug delivery technology are creating novel therapeutic approaches to the treatment of Parkinson's disease with levodopa and dopamine agonists. This article reviews those technologies which can be applied to Parkinson's disease, both for targetting the central nervous system with drugs, as well as for matching the appropriate rate controlled delivery with therapeutic needs. In particular, the possibility exists for eliminating erratic highs and lows of drug delivery to the brain, and to substitute rate controlled, constant drug delivery. Clinical investigations now in progress suggest that new technologies which deliver constant dopaminergic stimulation to patients with Parkinson's disease may not only eliminate the unpredictable swings in therapeutic efficacy in Parkinson patients with the "on/off" effect, but may even have a role in the future in preventing such fluctuations from developing in patients chronically treated with dopaminergic therapies.
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Affiliation(s)
- S M Stahl
- Neuroscience Research Centre, Merck Sharp & Dohme Research Laboratories, Harlow, Essex, U. K
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Hagen NA, O'Neill BP, Kelly PJ. Computer assisted stereotactic placement of Ommaya reservoirs for delivery of chemotherapeutic agents in cancer patients. J Neurooncol 1987; 5:273-6. [PMID: 3316522 DOI: 10.1007/bf00151231] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A new technique of Ommaya reservoir placement using computer assisted reconstruction of CT data bases is described. This technique permits stereotactic placement of ventricular catheters in small or normal sized ventricles. It should be particularly useful in patients where the conventional technique is not applicable.
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Affiliation(s)
- N A Hagen
- Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905
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Dinndorf PA, Bleyer WA. Management of infectious complications of intraventricular reservoirs in cancer patients: low incidence and successful treatment without reservoir removal. CANCER DRUG DELIVERY 1987; 4:105-17. [PMID: 3480777 DOI: 10.1089/cdd.1987.4.105] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
At the time of analysis, the first 30 patients with Ommaya reservoirs (OR) at the Children's Orthopedic Hospital and Medical Center in Seattle, Washington had had 32 reservoirs for a mean duration of 28 months. In all, the reservoir chambers had been punctured for either diagnostic or therapeutic purposes a total of 1,287 times with a mean of 40 injections per reservoir and 1.4 injections per month. Six reservoir infections were diagnosed in five patients--a rate of one infection for every 153 reservoir-months. Four infections were attributed to reservoir use--a rate of one infection for every 322 reservoir entries, and less than one infection in 900 entries when a standard aseptic protocol for sampling and injection was applied. There was no correlation between infectious complications and the frequency with which reservoirs were injected, but there was evidence that some of the infections resulted from incomplete compliance with recommended technique for skin preparation and reservoir entry. Four infections were treated successfully with intravenous and intra-reservoir antibiotics without reservoir removal. Only one reservoir had to be removed because of persistent infection. Two other reservoirs were removed because of trauma and malfunction. Twenty-seven patients (90%) retained their original reservoir, up to 9.5 years after implantation. Intraventricular chemotherapy via an indwelling subcutaneous reservoir is a preferred method for delivery of intrathecal chemotherapy, with an acceptable infection risk relative to the benefits of patient comfort and therapeutic efficacy.
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Affiliation(s)
- P A Dinndorf
- Children's Orthopedic Hospital and Medical Center, Seattle, WA
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Abstract
The narrow therapeutic index and potentially life-threatening toxicities of the antineoplastic agents require a clear understanding of their toxicologic and pharmacologic properties, particularly in infants and children. This article reviews the literature published in the last five years on pediatric cancer chemotherapy. It begins with an overview of new concepts in antineoplastic therapy and then summarizes each of the main drugs used to treat the cancer of infants and children.
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