Intracarotid infusion of cis-diamminedichloroplatinum in the treatment of recurrent malignant brain tumors

Abstract

Thirty‐five patients with malignant brain tumors (23 with primary brain tumors and 12 with brain metastases) progressing after cranial irradiation chemotherapy received cisplatin, 60 to 120 mg/m2, into the internal carotid artery by a transfemoral approach. Courses of therapy were repeated every 4 weeks. Therapeutic evaluation was performed monthly using the CT scan of the brain and clinical neurologic examination. Thirty patients were evaluable for response. Of 20 evaluable patients with primary malignant brain tumors, 6 responded to therapy and 5 had stable disease. The median time to tumor progression for responding patients was 33 weeks, for stable patients 16 weeks, and 13 weeks for all patients. Five of 10 evaluable patients with brain metastases responded to intracarotid cisplatin, and 2 patients had stable disease. The estimated median time to progression for responding patients was 30+ weeks and 12+ weeks for patients with stable disease. Side effects included seizures in 5 courses, mental agitation and motor restlessness in 1, and transient hemiparesis in 7. One patient may have had a drug‐related death, and one patient appeared to develop encephalopathy after treatment. Five patients had clinical deterioration in vision; in two patients it was bilateral. Intracarotid cisplatin has definite activity in patients with malignant primary brain tumors and in patients with brain metastases. The recommended starting dose for intracarotid cisplatin is 60 to 75 mg/m2. At this dose level side effects are uncommon, but includes the risk of neurologic and retinal toxicity.

Intra-arterial cisplatin for the treatment of malignant gliomas

“…Data from several studies showed that at least 60 mg/m 2 of IA DDP was adequate to achieve a response [14][15][16]. All but one of our patients received 75-100 mg/m 2 of DDP per dose.…”

“…Her partial response may have been from this fraction of tumor. The efficacy of IA DDP was less than that seen in most other trials of IV [12,13] or IA [14][15][16][17][18] administered DDP. Our response rate was also considerably less than those obtained with IV BCNU [3,4].…”

“…They were able to demonstrate that IA infusion of DDP (60 mg/m 2 q6 wks) via transfemoral selective interal carotid artery catheterization was technically feasible and capable of producing tumor regression or stabilization. Subsequent studies using IA DDP have also shown encouraging results against primary CNS tumors [15][16][17][18]. This report describes our experienc using IA DDP in the treatment of patients with malignant gliomas.…”

Treatment of recurrent malignant supratentorial gliomas with carboplatin (CBDCA)

“…Intraarterial infusions of cisplatin have been occasionally useful in patients with recurrent malignant gliomas, including patients previously treated with nitrosoureas [3]. Unfortunately, intraarterial cisplatin may induce severe neurological and ophthalmological complications [3]. Intravenous cisplatin has been successful in various neoplasms including CNS malignancies [4] but the administration of this drug was associated with a variety of toxicites.…”

“…Aida and Bodell [2] did not find cross resistance between chlornitrosoureas and cisplatinum on human malignant gliomas cell lines. Intraarterial infusions of cisplatin have been occasionally useful in patients with recurrent malignant gliomas, including patients previously treated with nitrosoureas [3]. Unfortunately, intraarterial cisplatin may induce severe neurological and ophthalmological complications [3].…”