Neuro-oncology

Irinotecan for brain metastases of breast and lung cancer -pro

Because irinotecan penetrates the brain-blood barrier and has an effect in primary brain cancer, there is some interest in using it for brain metastasis, especially for lung cancer and breast cancer. Most studies of irinotecan had been for brain mets of small(SCLC) and non-small cell lung cancer(NSMCLC) and not breast cancer and have had mixed results. One study reported complete responses with irinotecan-based chemotherapy for brain metastases in

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Accutane and Temodar for glioblastoma – pro

Not many options are available for progressive gliomas. Among them is Accutane, studied most in combination with temazolamide. A phase II trial (Radiation Therapy Oncology Group 91–13) of all-trans-retinoic acid in 30 patients with recurrent malignant glioma disclosed minor activity, with tolerable side effects; a response rate of 12% was observed, with a median time to progression of 3.8 months and a median OS of 5.7 months. A similar single-institution

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Sports for hemophiliacs – pro

Regular exercise strengthens muscles and protects joints, which can help reduce spontaneous bleeding. Some recommended activities include swimming, bicycling, walking, jogging, tennis, golfing, dancing, fishing, sailing and bowling. Most experts recommend that children with hemophilia avoid contact sports - such as football, hockey, boxing and wrestling. This information can be found in the Ntional Hemophilia Foundation publication "Hemophilia, Sports

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Tarceva for GBM – pro

Lay Summary: Tarceva is a promising new drug for GBM. There are a number of phase II trials of Tarceva. Researchers from the Cleveland Clinic Brain Tumor Institute have reported that Tarceva® (erlotinib) produced responses in more than 40% of patients with glioblastoma multiforme. These results were presented at the 29th European Society of Medical Oncology (ESMO) Congress held in Vienna, Austria, October 29 – November 3, 2004. Another  phase

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PET for brain cancer/ necrosis versus progression – pro

For PET brain cancers are not inlcuded in guidelines and CMS does not cover PET for this diangosis. Occasionally, PET can provide information to differntiate tumor necrosis from tumor progression. The sensitivity of PET for differentiating necrosis and tumor progression is 80%–90% and the specificity is 50%–90%. Causes of false-negative PET results include recent radiation therapy, low histologic grade, and small tumor volume. FDG PET may be

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Isotretinoin for glioblastomas – pro

Isotretinoin is a promising agent for glioblastoma. 13-cis-Retinoic acid (cRA) is a synthetic analog of vitamin A, which binds to all three subtypes of retinoic acid receptors (RARα, β, and γ) and retinoid X receptors (RXRα, β, and γ). RAR and RXR are members of the nuclear steroid receptor family, bind as homodimers or heterodimers to specific DNA response elements, and influence the transcription of relevant genes. Retinoids have diverse

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Sandostatin for meningioma – pro

Several preclincial reports and a small phase Ii study recently been published suggesting activity of Sandostatin in meningioma.  Somatostatin receptors, especially the sst2A subtype, are present on most meningiomas. The addition of somatostatin inhibits meningioma growth in vitro in some studies. There have been anecdotal reports of octreotide inhibiting growth in meningiomas. A prospective pilot trial of sustained-release somatostatin (Sandostatin

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Treatment of brain metastases – pro

Lay Summary: We overview treatment options for brain metastases. Surgical resection should be considered in patients with single brain metastasis in an accessible location, especially when the size is large, the mass effect is considerable and an obstructive hydrocephalus is present. Surgery is recommended when the systemic disease is absent/controlled and the Karnofsky Performance score is 70 or more (level A recommendation). When the combined resection

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Temodar and radiation for Oligodendroglioma – pro

Although not recommended by NCCN, or for that matter any study, most neuro-oncologists are now using combined Temodar and radiation postoperatively for anaplastic oligodendroglioma. Regardless of molecular genetic status, the most commonly recommended treatment in a questinnaire survey of neuro-oncologists was the use of concurrent temozolomide and radiotherapy followed by adjuvant temozolomide (18%-34%). The role of chemotherapy for the treatment

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Motefaxin gadollinium for brain metastases and gliblastoma – pro

Motexafin gadolinium is a member of a class of rationally designed porphyrin-like molecules called texaphyrins. The rationale for its use in cancer therapy is that, like naturally occurring porphyrins, it tends to concentrate selectively in cancer cells and it has a novel mechanism of action as it induces redox stress, triggering apoptosis in a broad range of cancers. RECENT FINDINGS: In vitro studies have shown that motexafin gadolinium is synergistic

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