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. 2000 Oct 26;83(10):1281–1286. doi: 10.1054/bjoc.2000.1459

High intratumoural accumulation of stealth® liposomal doxorubicin (Caelyx®) in glioblastomas and in metastatic brain tumours

M I Koukourakis 1,2, S Koukouraki 1,3, I Fezoulidis 2, N Kelekis 2, G Kyrias 2, S Archimandritis 4, N Karkavitsas 3
PMCID: PMC2408790  PMID: 11044350

Abstract

The blood–brain barrier is a major obstacle for the chemotherapeutic drugs to effectively reach primary or secondary brain tumours. Stealth® liposomal drugs are highly accumulated in tumoural tissues. In the present study we investigated the relative accumulation of99mTc-DTPA radiolabelled stealth® liposomal doxorubicin (Caelyx®) in 10 patients with metastatic brain tumours and five patients with brain glioblastoma undergoing radiotherapy. Patients with metastatic brain lesions were treated with 10 consecutive fractions of radiotherapy (whole brain, 3 Gy/fraction, day 1–12) followed by a booster dose of 9 Gy (3 Gy/fraction, day 21–23). Caelyx®, at a dose of 25 mg mg–2was given on day 1 and on day 21. Radiolabelled Caelyx® accumulation was 13–19 times higher in the glioblastomas and 7–13 times higher in the metastatic lesions, as compared to the normal brain. The drug accumulation in the tumoural areas was 40–60% of the accumulation in the bone marrow of the skull bones. The normal brain radioactivity was <4% of the bone marrow, confirming an important shielding effect of the blood–brain barrier in the normal but not in the tumoural tissue. Four of 10 patients with metastatic lesions showed a complete response in CT-scan performed 2 months following therapy. There was no severe toxicity related to radiotherapy or to chemotherapy noted. It is concluded that stealth® liposomal drugs selectively overcome the blood–brain barrier in the tumoural areas. The clinical importance of this observation is now under investigation. © 2000 Cancer Research Campaign

Keywords: brain metastasis, glioblastoma, stealth liposomal doxorubicin, radiotherapy

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Selected References

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  1. Abe T., Hasegawa S., Taniguchi K., Yokomizo A., Kuwano T., Ono M., Mori T., Hori S., Kohno K., Kuwano M. Possible involvement of multidrug-resistance-associated protein (MRP) gene expression in spontaneous drug resistance to vincristine, etoposide and adriamycin in human glioma cells. Int J Cancer. 1994 Sep 15;58(6):860–864. doi: 10.1002/ijc.2910580619. [DOI] [PubMed] [Google Scholar]
  2. Bonner J. A., Lawrence T. S. Doxorubicin decreases the repair of radiation-induced DNA damage. Int J Radiat Biol. 1990 Jan;57(1):55–64. doi: 10.1080/09553009014550341. [DOI] [PubMed] [Google Scholar]
  3. Cobbs C. S., Brenman J. E., Aldape K. D., Bredt D. S., Israel M. A. Expression of nitric oxide synthase in human central nervous system tumors. Cancer Res. 1995 Feb 15;55(4):727–730. [PubMed] [Google Scholar]
  4. Davis F. G., Freels S., Grutsch J., Barlas S., Brem S. Survival rates in patients with primary malignant brain tumors stratified by patient age and tumor histological type: an analysis based on Surveillance, Epidemiology, and End Results (SEER) data, 1973-1991. J Neurosurg. 1998 Jan;88(1):1–10. doi: 10.3171/jns.1998.88.1.0001. [DOI] [PubMed] [Google Scholar]
  5. Doolittle N. D., Petrillo A., Bell S., Cummings P., Eriksen S. Blood-brain barrier disruption for the treatment of malignant brain tumors: The National Program. J Neurosci Nurs. 1998 Apr;30(2):81–90. doi: 10.1097/01376517-199804000-00002. [DOI] [PubMed] [Google Scholar]
  6. Dvorak H. F., Nagy J. A., Dvorak J. T., Dvorak A. M. Identification and characterization of the blood vessels of solid tumors that are leaky to circulating macromolecules. Am J Pathol. 1988 Oct;133(1):95–109. [PMC free article] [PubMed] [Google Scholar]
  7. Fine H. A., Dear K. B., Loeffler J. S., Black P. M., Canellos G. P. Meta-analysis of radiation therapy with and without adjuvant chemotherapy for malignant gliomas in adults. Cancer. 1993 Apr 15;71(8):2585–2597. doi: 10.1002/1097-0142(19930415)71:8<2585::aid-cncr2820710825>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  8. Gabizon A., Catane R., Uziely B., Kaufman B., Safra T., Cohen R., Martin F., Huang A., Barenholz Y. Prolonged circulation time and enhanced accumulation in malignant exudates of doxorubicin encapsulated in polyethylene-glycol coated liposomes. Cancer Res. 1994 Feb 15;54(4):987–992. [PubMed] [Google Scholar]
  9. Gumerlock M. K., Belshe B. D., Madsen R., Watts C. Osmotic blood-brain barrier disruption and chemotherapy in the treatment of high grade malignant glioma: patient series and literature review. J Neurooncol. 1992 Jan;12(1):33–46. doi: 10.1007/BF00172455. [DOI] [PubMed] [Google Scholar]
  10. Khalifa A., Dodds D., Rampling R., Paterson J., Murray T. Liposomal distribution in malignant glioma: possibilities for therapy. Nucl Med Commun. 1997 Jan;18(1):17–23. doi: 10.1097/00006231-199701000-00005. [DOI] [PubMed] [Google Scholar]
  11. Koukourakis M. I., Giatromanolaki A., Kakolyris S., O'Byrne K. J., Apostolikas N., Skarlatos J., Gatter K. C., Harris A. L. Different patterns of stromal and cancer cell thymidine phosphorylase reactivity in non-small-cell lung cancer: impact on tumour neoangiogenesis and survival. Br J Cancer. 1998 May;77(10):1696–1703. doi: 10.1038/bjc.1998.280. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Koukourakis M. I., Koukouraki S., Giatromanolaki A., Archimandritis S. C., Skarlatos J., Beroukas K., Bizakis J. G., Retalis G., Karkavitsas N., Helidonis E. S. Liposomal doxorubicin and conventionally fractionated radiotherapy in the treatment of locally advanced non-small-cell lung cancer and head and neck cancer. J Clin Oncol. 1999 Nov;17(11):3512–3521. doi: 10.1200/JCO.1999.17.11.3512. [DOI] [PubMed] [Google Scholar]
  13. Lasic D. D., Martin F. J., Gabizon A., Huang S. K., Papahadjopoulos D. Sterically stabilized liposomes: a hypothesis on the molecular origin of the extended circulation times. Biochim Biophys Acta. 1991 Nov 18;1070(1):187–192. doi: 10.1016/0005-2736(91)90162-2. [DOI] [PubMed] [Google Scholar]
  14. Leon S. P., Folkerth R. D., Black P. M. Microvessel density is a prognostic indicator for patients with astroglial brain tumors. Cancer. 1996 Jan 15;77(2):362–372. doi: 10.1002/(SICI)1097-0142(19960115)77:2<362::AID-CNCR20>3.0.CO;2-Z. [DOI] [PubMed] [Google Scholar]
  15. Miller P. J., Hassanein R. S., Giri P. G., Kimler B. F., O'Boynick P., Evans R. G. Univariate and multivariate statistical analysis of high-grade gliomas: the relationship of radiation dose and other prognostic factors. Int J Radiat Oncol Biol Phys. 1990 Aug;19(2):275–280. doi: 10.1016/0360-3016(90)90534-q. [DOI] [PubMed] [Google Scholar]
  16. Nakagawa K., Aoki Y., Fujimaki T., Tago M., Terahara A., Karasawa K., Sakata K., Sasaki Y., Matsutani M., Akanuma A. High-dose conformal radiotherapy influenced the pattern of failure but did not improve survival in glioblastoma multiforme. Int J Radiat Oncol Biol Phys. 1998 Mar 15;40(5):1141–1149. doi: 10.1016/s0360-3016(97)00911-5. [DOI] [PubMed] [Google Scholar]
  17. Nelson D. F., Curran W. J., Jr, Scott C., Nelson J. S., Weinstein A. S., Ahmad K., Constine L. S., Murray K., Powlis W. D., Mohiuddin M. Hyperfractionated radiation therapy and bis-chlorethyl nitrosourea in the treatment of malignant glioma--possible advantage observed at 72.0 Gy in 1.2 Gy B.I.D. fractions: report of the Radiation Therapy Oncology Group Protocol 8302. Int J Radiat Oncol Biol Phys. 1993 Jan 15;25(2):193–207. doi: 10.1016/0360-3016(93)90340-2. [DOI] [PubMed] [Google Scholar]
  18. Paridaens R. Efficacy of paclitaxel or doxorubicin used as single agents in advanced breast cancer: a literature survey. Semin Oncol. 1998 Oct;25(5 Suppl 12):3–6. [PubMed] [Google Scholar]
  19. Plate K. H., Risau W. Angiogenesis in malignant gliomas. Glia. 1995 Nov;15(3):339–347. doi: 10.1002/glia.440150313. [DOI] [PubMed] [Google Scholar]
  20. Rahman A., Husain S. R., Siddiqui J., Verma M., Agresti M., Center M., Safa A. R., Glazer R. I. Liposome-mediated modulation of multidrug resistance in human HL-60 leukemia cells. J Natl Cancer Inst. 1992 Dec 16;84(24):1909–1915. doi: 10.1093/jnci/84.24.1909. [DOI] [PubMed] [Google Scholar]
  21. Riondel J., Jacrot M., Fessi H., Puisieux F., Potier Effects of free and liposome-encapsulated taxol on two brain tumors xenografted into nude mice. In Vivo. 1992 Jan-Feb;6(1):23–27. [PubMed] [Google Scholar]
  22. Sakayama K., Masuno H., Miyazaki T., Okumura H., Shibata T., Okuda H. Existence of lipoprotein lipase in human sarcomas and carcinomas. Jpn J Cancer Res. 1994 May;85(5):515–521. doi: 10.1111/j.1349-7006.1994.tb02389.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Sherman D. M., Carabell S. C., Belli J. A., Hellman S. The effect of dose rate and adriamycin on the tolerance of thoracic radiation in mice. Int J Radiat Oncol Biol Phys. 1982 Jan;8(1):45–51. doi: 10.1016/0360-3016(82)90383-2. [DOI] [PubMed] [Google Scholar]
  24. Shibata S., Ochi A., Mori K. Liposomes as carriers of cisplatin into the central nervous system--experiments with 9L gliomas in rats. Neurol Med Chir (Tokyo) 1990 Apr;30(4):242–245. doi: 10.2176/nmc.30.242. [DOI] [PubMed] [Google Scholar]
  25. Siegal T., Horowitz A., Gabizon A. Doxorubicin encapsulated in sterically stabilized liposomes for the treatment of a brain tumor model: biodistribution and therapeutic efficacy. J Neurosurg. 1995 Dec;83(6):1029–1037. doi: 10.3171/jns.1995.83.6.1029. [DOI] [PubMed] [Google Scholar]
  26. Stan A. C., Casares S., Radu D., Walter G. F., Brumeanu T. D. Doxorubicin-induced cell death in highly invasive human gliomas. Anticancer Res. 1999 Mar-Apr;19(2A):941–950. [PubMed] [Google Scholar]
  27. Valdivieso M., Burgess M. A., Ewer M. S., Mackay B., Wallace S., Benjamin R. S., Ali M. K., Bodey G. P., Freireich E. J. Increased therapeutic index of weekly doxorubicin in the therapy of non-small cell lung cancer: a prospective, randomized study. J Clin Oncol. 1984 Mar;2(3):207–214. doi: 10.1200/JCO.1984.2.3.207. [DOI] [PubMed] [Google Scholar]
  28. Warren L., Jardillier J. C., Malarska A., Akeli M. G. Increased accumulation of drugs in multidrug-resistant cells induced by liposomes. Cancer Res. 1992 Jun 1;52(11):3241–3245. [PubMed] [Google Scholar]

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