Hb. Newton et al., Clinical presentation, diagnosis, and pharmacotherapy of patients with primary brain tumors, ANN PHARMAC, 33(7-8), 1999, pp. 816-832
OBJECTIVE: TO briefly review the clinical presentation and diagnosis of pat
ients with primary brain tumors, followed by an in-depth; sun;ey of the per
tinent pharmacotherapy.
DATA SOURCES: A detailed search of the neurologic, neurosurgical, and oncol
ogic literature for basic science research, clinical studies, and review ar
ticles related to chemotherapy and pharmacotherapy of primary brain tumors.
STUDY SELECTION: Relevant studies on tissue culture systems, animals, and h
umans examining the mechanisms of action, pharmacokinetics, clinical pharma
cology, and treatment results of chemotherapeutic agents for primary brain
tumors. In addition, studies of pharmacologic agents administered for suppo
rtive care and symptom control are reviewed.
DATA SYNTHESIS: Primary brain tumors derive from cells within the intracran
ial cavity and generally present with headache, seizure activity, cognitive
changes, and weakness. They are diagnosed most efficiently with magnetic r
esonance imaging. After diagnosis, the most common supportive medications i
nclude corticosteroids, gastric acid inhibitors, and anticonvulsants. Chemo
therapy is adjunctive treatment for patients with malignant tumors and sele
cted recurrent or progressive benign neoplasms. In general, the most effect
ive chemotherapeutic drugs are alkylating agents such as the nitrosoureas,
procarbazine, cisplatin, and carboplatin. Other agents used include cycloph
osphamide, methotrexate. vincristine, and etoposide. Angiogenesis inhibitor
s and gene therapy comprise some of the novel therapeutic strategies under
investigation.
CONCLUSIONS: The efficacy of chemotherapy for primary brain tumors remains
modest. Novel agents must be discovered that are more specific and attack t
umor cells at the molecular level of tumorigenesis. Furthermore, strategies
must be developed to counteract the pervasive problem of brain tumor chemo
resistance.