PHARMACOLOGICAL STRATEGIES FOR THE TREATMENT OF MENINGEAL MALIGNANCY

There have been significant strides in the treatment and prevention of meningeal cancer, particularly meningeal leukemia, during the past th irty years. These advantages are a direct result of innovative therape utic approaches specifically designed to overcome the limitations of s ystemically administered chemotherapy. Such approaches include the adm inistration of intrathecal chemotherapy by intralumbar or intraventric ular injection, the administration of very high-dose systemic chemothe rapy, and the administration of cranial or craniospinal irradiation. A better understanding of the central nervous system pharmacokinetics o f commonly used anticancer agents has also resulted in improvements in the treatment of meningeal cancer. In this article, the clinical phar macology of the most commonly used intrathecal agents and pharmacologi c strategies for the treatment of meningeal cancer will be discussed. In addition, an overview of new agents for intrathecal administration and other novel CNS targeted therapies will be presented.