Volume 3 Issue 2, February 2006

Glioblastoma multiforme (GMB) is a devastating neoplasm that nearly always culminates in death within 1–2 years of diagnosis. Despite decades of intensive clinical and laboratory research, progress has been slow, partly because of limited drug delivery and tumor heterogeneity. David Reardon describes an innovative chemoradiation approach that has improved overall survival for newly diagnosed GBM patients, and details a number of promising therapeutic strategies under evaluation.

The Investigational New Drug (IND) process was established to ensure that the FDA is informed of any new treatment before use in humans. The process is now used for approval rather than notification. The time from conception to approval for a new drug is estimated at over 15 years, of which two-thirds is devoted to pre-IND testing. In the meantime the patient is denied access to the investigational treatment. A centralized IND procedure, when the public are already protected by processes within academic centers of excellence, is redundant and costs lives.

Cancer mortality is highest in cancer patients aged 65 years or older. Optimal chemotherapy dosing and regimens for these patients pose a significant challenge because of changes that occur with aging, as well as other comorbidities. This review discusses the important considerations for tailoring chemotherapy to the individual's performance and functional status.

Isolated limb perfusion (ILP) combined with melphalan and TNF-α produces striking response rates for the treatment of bulky melanoma metastases, soft tissue sarcomas and various other tumors. TNF-α-based ILP is a well-established treatment that helps to avoid amputations, and this represents an important approach that is now widely practiced in Europe.