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Intraarterial Therapy of Human Glioma Xenografts in Athymic Rats Using 4-Hydroperoxycyclophosphamide¹

Departments of Pathology [J. M. S., H. S. F., G. E. A., H. E. F., R. E. M., D. D. B.] and Pediatrics [H. S. F.] and the Preuss Laboratory for Brain Tumor Research [H. S. F., D. D. B.], Duke University Medical Center, Durham, North Carolina 27710 and the Johns Hopkins Oncology Center, Baltimore, Maryland 21205 [O. M. C.]

The addition of chemotherapy, notably using nitrosoureas, in the treatment of patients with glioblastoma multiforme has resulted in only modest improvements in long-term patient survival over the use of surgical intervention and irradiation alone. Intraarterial (i.a.) chemotherapy offers the potential benefit of increasing tumor drug delivery because of first-pass drug uptake, while minimizing systemic drug levels and toxicity. We have now investigated the i.a. therapy of intracerebral human glioma xenografts in athymic rats with 4-hydroperoxycyclophosphamide (4-HC), a preactivated derivative of cyclophosphamide. Athymic male rats were given intracerebral injections of the human glioma line D-54 MG. On Day 5 after injection, the rats were randomized (n = 8–10) by body weight (mean weight, approximately 300 g). In one set of experiments, each group received either i.v. saline, i.a. saline, 6 mg i.a. 4-HC, 6 mg i.v. 4-HC (6 mg), or 12 mg i.v. 4-HC. Intraarterial 4-HC produced significant increases in median survival (Day 24) compared with i.a. saline controls (140% increase), equivalent doses given i.v. (71% increase), and twice the equivalent dose given i.v. (50% increase) (by Wilcoxon rank sum analysis, P < 0.05 is statistically significant). The i.a. maximum tolerated dose was subsequently determined to be approximately 12.5 mg in non-tumor-bearing rats. Further experiments demonstrated a dose-response increase in survival for i.a. dosages of 6, 9, and 12.5 mg with significant improvement when compared with saline controls and 12.5 mg i.v. Pharmacokinetic experiments also demonstrated a significant first-pass uptake advantage for i.a. (versus i.v.) administered 4-HC. The short plasma half-life and marked antiglioma activity of 4-HC, without the need for hepatic activation, suggest a therapeutic application of this drug in the i.a. treatment of brain tumors.

¹ This work was supported by NIH Grants NS 20023, CA 56115, CA 11898, NS 00958, and CA 44640 and American Cancer Society Grant Ch 403C.

² To whom requests for reprints should be addressed, at Department of Pathology, Box 3156, Duke University Medical Center, Durham, NC 27710.

Received 11/25/92. Accepted 3/12/93.

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