Reni Michele, Mazza Elena, Foppoli Marco, Ferreri Andrés J M
Medical Oncology Unit, Department of Oncology, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy.
Cancer Lett. 2007 Dec 18;258(2):165-70. doi: 10.1016/j.canlet.2007.10.009. Epub 2007 Nov 13.
This review analyzes the major methodological caveats related to the design and conduction of trials addressing new active drugs in patients with failed primary CNS lymphoma (PCNSL) and provides some recommendations for their therapeutic management. The enrollment of patients in well-designed prospective trials is the best option at failure. In the clinical practice, radiotherapy is an option for unirradiated patients and re-treatment with high-dose methotrexate (HD-MTX) can be suggested to relapsing patients who experienced a prolonged lymphoma remission after first-line chemotherapy containing HD-MTX. Salvage monochemotherapy with temozolomide or topotecan in patients previously managed with a radiotherapy-containing approach is supported by prospective trials, while the combination chemotherapy remains investigational. High-dose chemotherapy supported by stem cell autotransplant and intrathecal chemotherapy in meningeal failure have to be further investigated in prospective trials.
本综述分析了与针对原发性中枢神经系统淋巴瘤（PCNSL）患者的新型活性药物试验设计和实施相关的主要方法学注意事项，并为其治疗管理提供了一些建议。在精心设计的前瞻性试验中纳入患者是治疗失败时的最佳选择。在临床实践中，放疗是未接受过放疗患者的一种选择，对于在含大剂量甲氨蝶呤（HD-MTX）的一线化疗后经历较长时间淋巴瘤缓解的复发患者，可建议再次使用HD-MTX进行治疗。前瞻性试验支持在先前接受过含放疗方案治疗的患者中使用替莫唑胺或拓扑替康进行挽救性单药化疗，而联合化疗仍处于研究阶段。在脑膜受累的情况下，由干细胞自体移植支持的大剂量化疗和鞘内化疗必须在前瞻性试验中进一步研究。
