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The Neuropharmacokinetics of Temozolomide in Patients with Resectable Brain Tumors: Potential Implications for the Current Approach to Chemoradiation
Ist Teil von
Clinical cancer research, 2009-11, Vol.15 (22), p.7092-7098
Ort / Verlag
United States: American Association for Cancer Research
Erscheinungsjahr
2009
Quelle
Free E-Journal (出版社公開部分のみ)
Beschreibungen/Notizen
Purpose: Intracerebral microdialysis (ICMD) is an accepted method for monitoring changes in neurochemistry from acute brain injury.
The goal of this pilot study was to determine the feasibility of using ICMD to examine the neuropharmacokinetics of temozolomide
in brain interstitium following oral administration.
Experimental Design: Patients with primary or metastatic brain tumors had a microdialysis catheter placed in peritumoral brain tissue at the time
of surgical debulking. Computerized tomography scan confirmed the catheter location. Patients received a single oral dose
of temozolomide (150 mg/m 2 ) on the first postoperative day, serial plasma and ICMD samples were collected over 24 hours, and temozolomide concentrations
were determined by tandem mass spectrometry.
Results: Nine patients were enrolled. Dialysate and plasma samples were successfully collected from seven of the nine patients. The
mean temozolomide areas under the concentration-time curve (AUC) in plasma and brain interstitium were 17.1 and 2.7 μg/mL
× hour, with an average brain interstitium/plasma AUC ratio of 17.8%. The mean peak temozolomide concentration in the brain
was 0.6 ± 0.3 μg/mL, and the mean time to reach peak level in brain was 2.0 ± 0.8 hours.
Conclusions: The use of ICMD to measure the neuropharmacokinetics of systemically administered chemotherapy is safe and feasible. Concentrations
of temozolomide in brain interstitium obtained by ICMD are consistent with published data obtained in a preclinical ICMD model,
as well as from clinical studies of cerebrospinal fluid. However, the delayed time required to achieve maximum temozolomide
concentrations in brain suggests that current chemoradiation regimens may be improved by administering temozolomide 2 to 3
hours before radiation. (Clin Cancer Res 2009;15(22):7092–8)