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Chemotherapy and immunotherapy in adult malignant gliomas
Abstract:
This review summarizes papers published during 1991 and 1992. The poor results obtained in the postneurosurgical treatment of gliomas led researchers to pursue attempts to try to overcome glioma cell resistance. The intra-arterial route was explored in several phase II studies with new drugs and even immunoconjugates; rates of response between 30% to 60% were obtained. New drugs (fotemustine, eflornithine, and estramustine) or combined protocols planned to circumvent chemoresistance were tested and showed some efficiency with moderate toxicity, enlarging the number of drugs available against malignant gliomas. On the contrary, two retrospective analyses warned about the risk of reduction of median time to survival due to adjuvant chemotherapy in anaplastic astrocytomas; this finding, if confirmed, would suggest to defer chemotherapy at the time of recurrence in this type of glial tumor. Immunobiologic therapies as immunomodifiers, immunoconjugates, or cytotoxic lymphocyte-activated killer cells and tumor-infiltrating lymphocytes were tested and allowed some responses to be obtained. In young children, chemotherapy regimens were found to be efficient in malignant plexus choroid carcinomas and low-grade gliomas, allowing radiation therapy to be deferred. Many studies were methodologically unsatisfactory because of uncertain pathology grouping, noncompliance to initial protocols, or too small populations of patients.
Insights
Researchers explored new treatments for gliomas, including intra-arterial drug delivery and immunotherapies, showing promising response rates. However, some studies suggest delaying chemotherapy for anaplastic astrocytomas until recurrence due to survival concerns.
Area of Science:
- Neuro-oncology
- Clinical Pharmacology
- Immunotherapy
Background:
- Malignant gliomas exhibit poor treatment outcomes, necessitating research into overcoming drug resistance.
- Advances in chemotherapy and immunotherapy are crucial for improving patient survival and quality of life.
Purpose of the Study:
- To review and synthesize findings from studies published in 1991-1992 on glioma treatment.
- To evaluate the efficacy and toxicity of novel therapeutic strategies against malignant gliomas.
Main Methods:
- Review of published papers from 1991-1992.
- Analysis of Phase II studies evaluating intra-arterial drug delivery and immunoconjugates.
- Assessment of new chemotherapeutic agents and combined protocols.
- Evaluation of immunobiologic therapies including immunomodifiers and cellular therapies.
Main Results:
- Intra-arterial administration of new drugs and immunoconjugates yielded response rates of 30-60%.
- New agents like fotemustine, eflornithine, and estramustine demonstrated efficacy with moderate toxicity.
- Retrospective analyses indicated potential survival reduction with adjuvant chemotherapy in anaplastic astrocytomas.
- Immunotherapies showed some positive responses.
- Chemotherapy regimens were effective in pediatric malignant plexus choroid carcinomas and low-grade gliomas, potentially deferring radiation therapy.
Conclusions:
- Novel therapeutic approaches, including intra-arterial delivery and immunotherapy, offer potential for improved glioma treatment.
- Careful consideration of chemotherapy timing, particularly in anaplastic astrocytomas, is warranted.
- Methodological limitations in many studies necessitate cautious interpretation of results and further rigorous research.