Chemotherapy for glioma and primary central nervous system lymphoma

概要

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Among brain tumors arising intracranially or in thecentral nervous system (CNS), primary malignant brain tumors, especially gliomas or primary CNS lymphomas (PCNSLs), remain intractable despite multimodality of treatments including surgical resection, radiotherapy, and chemotherapy. Recent progress in medical technology and pharmacology has resulted in improvement of outcome of patients with these neoplasms, and the accurate diagnosis and proper application of standard chemotherapy have become more important for their management. One of the major differences in the CNS from other organs is the existence of the blood-brain barrier (BBB), which hampers penetration into brain parenchyma of most of regular chemotherapeutic agents used as standards for other malignancies, leading to lack of efficacy. Temozolomide is an oral alkylating agent with the excellent BBB penetration property, and has been shown significant efficacy in the treatment of glioblastoma, the most malignant glioma. Another promising agent for glioblastoma, bevacizumab, a humanized monoclonal antibody to the potent angiogenic factor VEGF, has been under intensive investigations. High-dose methotrexate, which passes through BBB, has been the standard of care for patients with PCNSL, and its combinations with multiple cytotoxic and immunologic agents have been tested in clinical trials. Here I present and discuss about current trends of chemotherapy for these brain tumors.