Document Detail


Effects of drug efflux on convection-enhanced paclitaxel delivery to malignant gliomas: technical note.
MedLine Citation:
PMID:  17986926     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Convection-enhanced delivery (CED) is an approach in local brain tumor treatment. The spread of infusate in CED can be thought of as involving three phases: backflow, convection, and diffusion. Uncontrolled backflow may lead to efflux of the infusate outside the cranium. METHODS: Based on an interim analysis of a clinical trial, the effects of drug efflux on convection were assessed. In a Phase I/II trial, eight patients with recurrent glioblastomas were treated with CED of paclitaxel. The first group of patients was treated with paclitaxel at a concentration of 0.5 mg/ml according to previously approved protocols. RESULTS: These Group 1 patients developed severe skin necrosis due to an efflux of paclitaxel out of the cranium. The average volume of distribution (Vd) in these patients was 12.8 cm. To prevent paclitaxel efflux, the burr hole was sealed with bone wax during and after CED in Groups 2 and 3. Surprisingly, patients in Group 2 showed a larger Vd (22.9 cm per catheter), exceeding the boundaries of the previous tumor, which led to subsequent neurological deficits. To allow a large Vd without severe side effects, the infusion volume was maintained, but the concentration of paclitaxel was reduced (paclitaxel concentration in Group 3, 0.25 mg/ml). CONCLUSION: Vd remained high and no adverse effects were seen in Group 3. Sealing the burr hole during CED prevented efflux. The simple measure of sealing seems to increase Vd. These data demonstrate that uncontrolled backflow may have an important impact on CED and must be avoided.
Authors:
Philipp G Tanner; Markus Holtmannspötter; Jörg-Christian Tonn; Roland Goldbrunner
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Publication Detail:
Type:  Clinical Trial, Phase I; Clinical Trial, Phase II; Comparative Study; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  61     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-11-07     Completed Date:  2007-12-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E880-2; discussion E882     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Klinikum Grosshadern, University of Munich, Munich, Germany. philipp.tanner@gmx.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Brain Neoplasms / drug therapy,  metabolism*
Convection*
Drug Delivery Systems / methods
Female
Glioma / drug therapy,  metabolism*
Humans
Infusions, Intralesional / methods*
Male
Middle Aged
Paclitaxel / administration & dosage,  pharmacokinetics*
Chemical
Reg. No./Substance:
33069-62-4/Paclitaxel

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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