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The Role of Chemotherapy in the Treatment of Malignant Astrocytomas

Published online by Cambridge University Press:  02 December 2014

David Mathieu  and
David Fortin
David Mathieu
Affiliation:
Divisions of Neurosurgery/Neuro-Oncology, Department of Surgery, Sherbrooke University and Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
David Fortin*
Affiliation:
Divisions of Neurosurgery/Neuro-Oncology, Department of Surgery, Sherbrooke University and Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
*
Centre Hospitalier Universitaire de Sherbrooke (CHUS), 3001 - 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada.
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Abstract:

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Malignant astrocytomas are aggressive neoplasms with a dismal prognosis despite optimal treatment. Maximal resective surgery is traditionally complemented by radiation therapy. Chemotherapy is now used on patients as initial therapy when their functional status is congruent with further treatment. The classic agents used are nitrosoureas, but temozolomide has taken the front seat recently, with recent data demonstrating increased survival when this agent is used concurrently with radiation therapy in newly diagnosed glioblastoma patients. A new class of agents, refered to as biological modifiers, are increasingly used in clinical trials in an effort to affect the intrinsic biologic aberrations harboured by tumor cells. These drugs comprise differentiation agents, anti-angiogenic agents, matrix-metalloproteinase inhibitors and signal transduction inhibitors, among others. This article reviews the standard cytotoxic agents that have been used to treat malignant astrocytomas, and the different combination regimens offering promise. In addition, recent advances with biological modifiers are also discussed.

Résumé:

RÉSUMÉ:

Les astrocytomes malins sont des tumeurs agressives dont le pronostic est sombre en dépit d’un traitement optimal. Traditionnellement, la radiothérapie servait de complément à la résection maximale. La chimiothérapie est maintenant utilisée initialement, si l’état du patient le justifie. Les agents classiques utilisés sont les nitrosourées. Cependant, le temozolomide les a supplantées récemment parce qu’on a observé une prolongation de la survie quand cet agent est utilisé en meme temps que la radiothérapie chez les nouveaux patients. Une nouvelle classe d’agents, des modificateurs de la réponse biologique, font l’objet d’essais thérapeutiques de plus en plus nombreux pour tenter de contrecarrer les aberrations biologiques intrinsèques des cellules tumorales. Parmi ces substances, notons des agents de différenciation, des agents antiangiogéniques, des inhibiteurs des métalloprotéinases matricielles et des inhibiteurs de la transduction du signal. Cet article revoit les agents cytotoxiques standards utilisés dans le traitement des astrocytomes malins et les différentes combinaisons thérapeutiques prometteuses ainsi que les progrès récents réalisés dans l’étude des modificateurs de la réponse biologique.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 33 , Issue 2 , May 2006 , pp. 127 - 140
Copyright
Copyright © The Canadian Journal of Neurological 2006

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