Improving the Brain Delivery of Chemotherapeutic Drugs in Childhood Brain Tumors

Palma Maurizi, Stefano Mastrangelo, Antonio Ruggiero, Giorgio Attina', Michele Antonio Capozza

Risultato della ricerca: Contributo in rivistaArticolo in rivistapeer review

17 Citazioni (Scopus)

Abstract

The central nervous system (CNS) may be considered as a sanctuary site, protected from systemic chemotherapy by the meninges, the cerebrospinal fluid (CSF) and the blood-brain barrier (BBB). Consequently, parenchymal and CSF exposure of most antineoplastic agents following intravenous (IV) administration is lower than systemic exposure. In this review, we describe the different strategies developed to improve delivery of antineoplastic agents into the brain in primary and metastatic CNS tumors. We observed that several methods, such as BBB disruption (BBBD), intra-arterial (IA) and intracavitary chemotherapy, are not routinely used because of their invasiveness and potentially serious adverse effects. Conversely, intrathecal (IT) chemotherapy has been safely and widely practiced in the treatment of pediatric primary and metastatic tumors, replacing the neurotoxic cranial irradiation for the treatment of childhood lymphoma and acute lymphoblastic leukemia (ALL). IT chemotherapy may be achieved through lumbar puncture (LP) or across the Ommaya intraventricular reservoir, which are both described in this review. Additionally, we overviewed pharmacokinetics and toxic aspects of the main IT antineoplastic drugs employed for primary or metastatic childhood CNS tumors (such as methotrexate, cytosine arabinoside, hydrocortisone), with a concise focus on new and less used IT antineoplastic agents.
Lingua originaleEnglish
pagine (da-a)824-N/A
RivistaCancers
Volume11
DOI
Stato di pubblicazionePubblicato - 2019

Keywords

  • Ommaya reservoir
  • blood-brain barrier (BBB)
  • cerebrospinal fluid (CSF)
  • intrathecal (IT) chemotherapy
  • lumbar puncture (LP)
  • personalized medicine

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