Intra-Arterial Chemotherapy with Carboplatin (CBDCA) and Vepesid (VP16) in Primary Malignant Brain Tumours

Abstract

Twenty three patients (18 males) were followed from January 1993 to July 1996 for primary central nervous system malignancy: glioblastoma multiforme (GM) (15 patients), anaplastic astrocytoma (AA) (8 patients). Ninety one cycles (average 4 cycles per patient) of intraarterial chemotherapy (IACH) were administered. The IACH included: Carboplatin (CBP) 250 mg/m2 and Vepesid (VP16) 150 mg/m2 infusion; both drugs in normal saline, 100 ml and 250 ml, were infused over 15 and 30 min respectively. IACH was repeated every two weeks four or six times according to response to chemotherapy. IACH was preceded by i.v. methylprednisolone 40mg and pure anti-emetic (5HT3 serotonin uptake inhibitors) and subcutaneous daily doses of G-CSF following IACH to prevent neutropenia. The whole treatment required a 24h hospital admission. The IACH was well-tolerated and toxicity (Miller's grade, WHO) included: two cases of reversible pulmonary embolism (8.6%) three and ten days respectively after therapy (one patient had atrial fibrillation, two cases grade 2 vomiting, two grade 1 anaemia and three grade 3 thombocytopenia (13%). Response to therapy was evaluated in 21 out of 23 patients, two having not yet received at least four IACH cycles: 4 PRO (3 GM, 1 AA), 15 SD (10 GM, 5 AA) and 2 PR (AA). Seventeen patients responded to IACH (SD + RO) (74%), and the PRs belonged to the AA group. Survival duration was from 16 + to 108 weeks. IACH with CP and VP16 warrants further studies focussing on drug dose and schedule. A prospective randomized multicentric trial evaluating radiotherapy and systemic chemotherapy plus/minus IACH is currently underway.