Pharmacokinetic considerations in the treatment of CNS tumours

Susannah Motl, Yanli Zhuang, Christopher Waters, Clinton F. Stewart

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Despite aggressive therapy, the majority of primary and metastatic brain tumour patients have a poor prognosis with brief survival periods. This is because of the different pharmacokinetic parameters of systemically administered chemotherapeutic agents between the brain and the rest of the body. Specifically, before systemically administered drugs can distribute into the CNS, they must cross two membrane barriers, the blood-brain barrier (BBB) and blood-cerebrospinal fluid (CSF) barrier (BCB). To some extent, these structures function to exclude xenobiotics, such as anticancer drugs, from the brain. An understanding of these unique barriers is essential to predict when and how systemically administered drugs will be transported to the brain. Specifically, factors such as physiological variables (e.g. blood flow), physicochemical properties of the drug (e.g. molecular weight), as well as influx and efflux transporter expression at the BBB and BCB (e.g. adenosine triphosphate-binding cassette transporters) determine what compounds reach the CNS. A large body of preclinical and clinical research exists regarding brain penetration of anticancer agents. In most cases, a surrogate endpoint (i.e. CSF to plasma area under the concentration-time curve [AUC] ratio) is used to describe how effectively agents can be transported into the CNS. Some agents, such as the topoisomerase I inhibitor, topotecan, have high CSF to plasma AUC ratios, making them valid therapeutic options for primary and metastatic brain tumours. In contrast, other agents like the oral tyrosine kinase inhibitor, imatinib, have a low CSF to plasma AUC ratio. Knowledge of these data can have important clinical implications. For example, it is now known that chronic myelogenous leukaemia patients treated with imatinib might need additional CNS prophylaxis. Since most anticancer agents have limited brain penetration, new pharmacological approaches are needed to enhance delivery into the brain. BBB disruption, regional administration of chemotherapy and transporter modulation are all currently being evaluated in an effort to improve therapeutic outcomes. Additionally, since many chemotherapeutic agents are metabolised by the cytochrome P450 3A enzyme system, minimising drug interactions by avoiding concomitant drug therapies that are also metabolised through this system may potentially enhance outcomes. Specifically, the use of non-enzyme-inducing antiepileptic drugs and curtailing nonessential corticosteroid use may have an impact.

Original languageEnglish (US)
Pages (from-to)871-903
Number of pages33
JournalClinical Pharmacokinetics
Volume45
Issue number9
DOIs
StatePublished - Sep 7 2006

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Pharmacokinetics
Cerebrospinal Fluid
Brain
Blood-Brain Barrier
Neoplasms
Brain Neoplasms
Pharmaceutical Preparations
Antineoplastic Agents
Therapeutics
Topoisomerase I Inhibitors
Topotecan
Drug Therapy
Cytochrome P-450 CYP3A
Xenobiotics
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Drug Interactions
Anticonvulsants
Protein-Tyrosine Kinases
Cytochrome P-450 Enzyme System
Adrenal Cortex Hormones

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Pharmacology (medical)

Cite this

Pharmacokinetic considerations in the treatment of CNS tumours. / Motl, Susannah; Zhuang, Yanli; Waters, Christopher; Stewart, Clinton F.

In: Clinical Pharmacokinetics, Vol. 45, No. 9, 07.09.2006, p. 871-903.

Research output: Contribution to journalArticle

Motl, Susannah ; Zhuang, Yanli ; Waters, Christopher ; Stewart, Clinton F. / Pharmacokinetic considerations in the treatment of CNS tumours. In: Clinical Pharmacokinetics. 2006 ; Vol. 45, No. 9. pp. 871-903.
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