Clinical Development of Experimental Therapies for Malignant Glioma
Journal Title: Sultan Qaboos University Medical Journal - Year 2011, Vol 11, Issue 1
Abstract
Advances in medical and surgical treatments in the last two to three decades have resulted in quantum leaps in the overall survival of patients with many types of non-central nervous system (CNS) malignant disease, while survival of patients with malignant gliomas (WHO grades 3 and 4) has only moderately improved. Surgical resection, external fractionated radiotherapy and oral chemotherapy, during and after irradiation, remain the pillars of malignant glioma therapy and have shown signifcant benefts. However, numerous clinical trials with adjuvant agents, most of them administered systemically and causing serious complications and side effects, have not achieved a noteworthy extension of survival, or only with considerable deterioration in patients’ quality of life. Signifcant attention was focussed in the last decades on the cell biology and molecular genetics of gliomas. Improved understanding of the fundamental features of tumour cells has resulted in the introduction and increasing clinical use of local therapies, which employ spatially defned delivery methods and tumour-selective agents specifcally designed to be used in the environment of a glioma-invaded brain. Tis review summarises the key fndings of some of the most recent and important clinical studies of locally administered novel treatments for malignant glioma. Several such therapies have shown considerable anti-tumour activity and a favourable profle of local and systemic side effects. Tese include biodegradable polymers for interstitial chemotherapy, targeted toxins administered by convection enhanced delivery, and intra- and peritumourally injected genetically modifed viruses conferring glioma-selective toxicity. Areas of possible improvement of these therapies and essential future developments are also outlined.
Authors and Affiliations
Nikolai G Rainov| Department of Neurosurgery, Klinikum Augsburg, D-86156 Augsburg, Germany, Volkmar Heidecke| Department of Neurosurgery, Klinikum Augsburg, D-86156 Augsburg, Germany
Keywords
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