Basis and results of chemotherapeutic treatment of gliomas

Brain tumor chemotherapy has improved in recent years with increasing knowledge of the requirements for effective drugs (such as lipophilicity and low molecular weight in order to enter brain tissue, and ability to kill proliferating and non-proliferating cells) and the evolution of criteria for statistically evaluable studies. In Phase II studies BCNU is the best single agent so far, giving a response rate of 51 per 100 for a median duration of 9 months. CCNU and procarbazine are also effective, while epipodophyllotoxin, DTIC, BIC, methotrexate and vincristine are somewhat less so. Recent Phase III studies have shown unequivocally that radiotherapy is effective; BCNU and radiation therapy together appear at present the best available treatment following surgery. Combinations of drugs as well as new drugs are a major source of hope for the future in these tumors with their still inexorably fatal courses.