Brain Cancer

BRAIN CANCER

Chemotherapy has only limited efficacy in the treatment of malig-nant gliomas. In general, the nitrosoureas, because of their ability to cross the blood-brain barrier, are the most active agents in this disease. Carmustine (BCNU) can be used as a single agent, or lomustine (CCNU) can be used in combination with procarbazine and vincristine (PCV regimen). In addition, the newer alkylating agent temozolomide is active when combined with radiotherapy and used in patients with newly diagnosed glioblastoma multi-forme (GBM) as well as in those with recurrent disease. The histo-pathologic subtype oligodendroglioma has been shown to be especially chemosensitive, and the PCV regimen is the treatment of choice for this disease. There is growing evidence that the anti-VEGF antibody bevacizumab alone or in combination with che-motherapy has promising activity in adult GBM, and bevacizumab was recently approved as a single agent for GBM in the setting of progressive disease following first-line chemotherapy. Of note, small molecule inhibitors of VEGFR-TKs are also undergoing active clinical development because they show interesting activity in adult brain tumors.