Abstract
1) Adjuvant chemotherpay for high-grade gliomas. The randomized clinical trials BTSG 69-01, 72-01, 75-01 and RTOG7401/ECOG1374 showed radiotherapy plus chemotherapy with nitrosoureas offered a long term survival advantage to patients younger than 60 years old. Combination chemotherapy, such as PCV, gava a survival advantage to patients with anaplastic gliomas in one study and it shouuld be tested furthermore. Intra-artrial chemotherapy with nitrosoureas did not offer a survival advantage. 2) Chemotherapy for anaplastic oligodendroglioma and anaplastic oligoastrocytoma. Combination chemotherapy with PCV was effective in patients with anaplastic oligodendroglioma and anaplastic oligoastrocytoma and it was shown that 1 pLOH was the predictor of chemosensitivity. 3) Drug resistance. The MGMT level in tumor tissue correlated with survival of patients who were treated with BCNU. 4) New drugs. Temozolomide is the most promising drug and a phase II randomized study in patients with glioblastoma at first relapse showed a survival advantage of temozolomide over procarbazine. 5) Future directions. The genetic predictors of chemosensitivity, methods overcoming drug resistance, and drugs with new mechanisms of action such as signal transduction inhibitor and angiogenesis inhibitor are undergoing preclinical and clinical testing.
