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.
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