Craniopharyngioma medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Marjan Khan M.B.B.S.[2]

Overview

The predominant therapy for craniopharyngioma is surgical resection. Adjunctive chemotherapy and radiation may be required. Subcutaneous pegylated interferon alpha-2B has been used to treat cystic recurrences. It can also be treated with intracavitary instillation of radioactive P-32, bleomycin or interferon-alpha via stereotactic delivery or placement of an Ommaya catheter. Paclitaxel and carboplatin have shown to prevent recurrence of malignant craniopharyngiomas.Intracavitary bleomycin reduces cyst size and toughens and thickens the cyst wall, thereby facilitating surgical excision of a cyst membrane that otherwise might fragment at the time of open craniotomy. Reports of intracystic bleomycin use are limited. Other agents like interferon alpha are being tested in recent days.

Medical Therapy

• Although the mainstay of therapy for craniopharyngioma is surgery with or without radiation, there are certain indications for medical therapy as well, mostly in treating recurrent tumors.
• Although systemic therapy is generally not utilized, it has been shown that the use of subcutaneous pegylated interferon alpha-2b to manage cystic recurrences can result in durable responses.
• The chemotherapy drugs Paclitaxel and Carboplatin have shown a clinical significance in increasing the survival rate in patients who've had gross total resections of their malignant tumors.
• Cystic recurrences may be treated with intracavitary instillation of varying agents via stereotactic delivery or placement of an Ommaya catheter. These agents have included radioactive P-32 or other radioactive compounds, bleomycin or interferon-alpha. These strategies have been found to be useful in certain cases, and a low risk of complications has been reported. However, none of these approaches have shown efficacy against solid portions of the tumor.
• The following is an example of a national and/or institutional phase II clinical trial that is currently being conducted. PBTC-039 (NCT01964300) (Peginterferon Alpha-2b) in treating younger patients with craniopharyngioma that is recurrent or cannot be removed by surgery.

References

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