Revisiting intrathecal thiotepa: Efficacy and safety in secondary CNS malignancies.

Autor: Jamison T; Department of Medicine, Baylor College of Medicine, Houston, TX, USA., Haque E; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia., Muhsen IN; Section of Hematology and Oncology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA., Samarkandi H; Oncology Pharmacy Services, Faisal Specialist Hospital and Research Center, Riyadh, King, Saudi Arabia., Fakih RE; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.; Transplantation and Cellular Therapy Section, Oncology Center, King Faisal Specialist Hospital and Research Center, 11211, Riyadh, Saudi Arabia., Aljurf M; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. maljurf@kfshrc.edu.sa.; Transplantation and Cellular Therapy Section, Oncology Center, King Faisal Specialist Hospital and Research Center, 11211, Riyadh, Saudi Arabia. maljurf@kfshrc.edu.sa.
Jazyk: angličtina
Zdroj: Medical oncology (Northwood, London, England) [Med Oncol] 2024 Jun 17; Vol. 41 (7), pp. 177. Date of Electronic Publication: 2024 Jun 17.
DOI: 10.1007/s12032-024-02401-w
Abstrakt: Treating metastatic malignancies to the central nervous system (CNS) is challenging because many drugs cannot cross the blood-brain-barrier (BBB). Direct intrathecal (IT) drug administration into the cerebrospinal fluid (CSF) is a strategy to overcome this problem. Thiotepa has effective CNS penetration but its popularity has waned over the last two decades due to concerns about its efficacy and potential systemic toxicity. This review evaluates the available evidence for the use of IT thiotepa in hematologic malignancies and non-CNS solid tumors with leptomeningeal disease metastases (LMD). Our search shows that IT thiotepa is a reasonable alternative in hematologic malignancies and LMD due to solid organ malignancies. This suggests a potential role of IT thiotepa in second-or third-line treatment or a substitute role in cases of drug-shortages and adverse effects with other agents. Future research should focus on rigorous comparative trials to establish its definitive role in the evolving landscape of CNS-directed chemotherapy.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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