Pharmacotherapy for Primary CNS Lymphoma: Progress Beyond Methotrexate?

Graber, Jerome J.; Omuro, Antonio
June 2011
CNS Drugs;2011, Vol. 25 Issue 6, p447
Academic Journal
Studies conducted in the 1990s have established that high-dose metho- trexate-based chemotherapy added to whole-brain radiotherapy improves survival in primary CNS lymphoma (PCNSL). However, radiotherapy-related delayed neurotoxicity has emerged as a serious complication of chemo- radiotherapy, particularly in the elderly. Unfortunately, omitting radiotherapy results in decreased progression-free survival, and therefore establishing more effective chemotherapy regimens is necessary in order to improve the number of long-term remissions. Recent studies have suggested that a combination of drugs is superior to single-agent methotrexate, but the optimal chemotherapy combination and the role of alternative consolidation treatments such as reduced-dose radiotherapy and high-dose chemotherapy with stem cell rescue remain to be defined. In this article, we review the multiple chemotherapy options reported in newly diagnosed and in progressive/ refractory PCNSL, including recently reported and ongoing clinical trials, as well as future perspectives.


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