CARMUSTINE IMPLANTS - POTENTIAL IN THE TREATMENT OF BRAIN-TUMORS

In an effort to improve survival in patients with high-grade brain tum ours, it was hypothesised that local delivery of carmustine (BCNU) to these tumours would prolong survival. By implanting a polymer impregna ted with carmustine into the tumour resection cavity, it was hoped tha t high local drug concentrations could be achieved over a sustained ti me period with minimal systemic concentrations or toxicity. This hypot hesis was tested in the laboratory, and the use of a carmustine polyme r was found to be safe and efficacious in a rodent brain tumour model. Based on the preclinical laboratory studies, a series of clinical stu dies were carried out to evaluate the safety and efficacy of this trea tment. Two phase III randomised, placebo-controlled studies have been completed evaluating the use of a carmustine polymer in patients at th e time of recurrence and as initial therapy. Both studies demonstrated that carmustine polymers resulted in prolonged survival. These studie s establish the principle that local delivery by a polymer is an effic acious drug delivery strategy. Furthermore, these studies demonstrate that local delivery of carmustine by the polymer is an effective treat ment for patients with high-grade gliomas.