Revisiting intrathecal thiotepa: Efficacy and safety in secondary CNS malignancies
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 penetra...
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| Veröffentlicht in: | Medical oncology (Northwood, London, England) London, England), 2024-06, Vol.41 (7), p.177, Article 177 |
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| creator | Jamison, Trevor Haque, Emaan Muhsen, Ibrahim N. Samarkandi, Hadeel Fakih, Riad El Aljurf, Mahmoud |
| description | 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. |
| doi_str_mv | 10.1007/s12032-024-02401-w |
| format | Article |
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| subjects | Antineoplastic Agents, Alkylating - administration & dosage Antineoplastic Agents, Alkylating - adverse effects Blood cancer Brain research Case reports Cellular biology Central Nervous System Neoplasms - drug therapy Central Nervous System Neoplasms - secondary Cerebrospinal fluid Chemotherapy Disease prevention Drug dosages Hematologic Neoplasms - drug therapy Hematology Humans Injections, Spinal Internal Medicine Leukemia Lymphoma Medicine Medicine & Public Health Meningeal Neoplasms - drug therapy Meningeal Neoplasms - secondary Metastasis Multiple myeloma Nervous system Oncology Pathology Patients Pediatrics Remission (Medicine) Review Article Thiotepa - administration & dosage Thiotepa - adverse effects Toxicity |
| title | Revisiting intrathecal thiotepa: Efficacy and safety in secondary CNS malignancies |
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