May 7, 2003
An innovative treatment for the deadliest brain cancer consisting of pharmaceutical wafers applied directly to the brain in lieu of traditional intravenous chemotherapy has recently been shown to extend the lives of patients with early-stage disease, according to a physician-scientist at Weill Cornell Medical Center. Dr. Susan Pannullo, Director of the Division of Neuro-Oncology at NewYork-Presbyterian Hospital Weill Cornell Medical Center, will discuss the treatment today (May 7), at The Delaware Valley Brain Tumor Support Group in Philadelphia, as part of National Brain Cancer Awareness Week, May 5-12.
The FDA-approved treatment, which involves the implanting of dime-sized GLIADEL wafers in the brain cavity following surgical removal of the glioma tumor, has shown to have a dramatic benefit for early stage brain tumor patients. A study published this year shows that patients with early-stage gliomas treated with GLIADEL live, on average, 26 percent longer than patients with traditional intravenous therapy (13.5 months vs. 10 months).
Both treatments contain the same chemotherapy agent, but unlike intravenous chemotherapy, which has difficulty crossing the blood-brain barrier, GLIADEL achieves superior drug concentration on the tumor and without the systemic toxicity and side effects associated with systemic treatment, said Dr. Susan Pannullo, Assistant Professor of Neurological Surgery at Weill Cornell Medical College and Assistant Attending Surgeon in Neurological Surgery at NewYork-Presbyterian Hospital Weill Cornell Medical Center.
Each year there are approximately 17,500 new Americans diagnosed with primary malignant gliomas and more than 10,000 deaths. Patients with malignant gliomas typically show symptoms of neurological dysfunction, such as headache, vomiting, confusion, memory difficulties, weakness, visual changes, or sensory alteration. The median survival of patients with malignant gliomas is one year.
Because of the infiltrative nature of malignant gliomas, complete surgical removal of the cancer is generally not possible and local recurrence is common. Consequently, many patients undergo successive operations. With surgery alone, median survival is approximately four months. Adding postoperative external beam radiation increases survival 18 to 22 weeks. The further addition of systematic chemotherapy provides little, if any, additional benefit.
GLIADEL was FDA-approved for treatment of late-stage brain tumors in 1996, and approved for treatment of early-stage brain tumors on February 26, 2003, following a landmark study, published in Neuro-Oncology, that demonstrated the treatment's effectiveness and safety.
Dr. Pannullo and Dr. Casilda Balmaceda, Assistant Clinical Professor of Neurology and Neurosurgery at Columbia University College of Physicians & Surgeons and Assistant Attending Neurologist and Neurosurgeon at NewYork-Presbyterian Hospital Columbia University Medical Center, are planning a clinical trial that will be the first to use MR spectroscopy to study how GLIADEL affects the tumor and the surrounding brain.
The GLIADEL wafer, manufactured by Guilford Pharmaceuticals of Baltimore, Maryland, is a 200 mg biodegradable wafer composed of a copolymer matrix containing 7.7 mg of chemotherapy agent, BCNU (1,3-bischolorethyl-nitrosourea). In vitro and in vivo studies have shown that BCNU release continues for two to three weeks, achieving concentrations at the tumor site approximately 100-fold greater than those achieved after intravenous BCNU administration.
Weill Cornell's Neuro-Oncology division offers the full spectrum of traditional and new and innovative treatments including, surgery, radiation therapy, stereotactic radiosurgery, chemotherapy, immune therapy, and complementary therapies. The Department's work, supported, in part, by research grants and direct contributions to the New York Brain Tumor Project, is also the site of promising research.