Note that in this case series the majority of patients did not present meningeal irritation signs/symptoms at disease onset. When considering the toxicity profile, only one grade 4 toxicity occurred. In a melanoma patient, an inflammatory encephalopathy picture with seizures, stupor, signs of meningeal irritation, nausea, moderate increase in temperature took Inhibitors,research,lifescience,medical place starting 24 hours after intraventricular administration of 50mg of liposomal AraC; concomitantly, a slight intraventricular CSF lymphocytosis was detected. The encephalopathy improved progressively leading to recovery of the premorbid status within 72 hours. CSF

culture was negative for infectious complications. 4 more patients displayed moderate postinjection headache and slight fever, usually starting within 24 hours from intrathecal delivery of liposomal AraC and receding in 1 to 2 days. 2 patients—both buy GSK J4 affected by metastatic breast cancer—are alive at a followup ranging from 11 to Inhibitors,research,lifescience,medical 23 months. 5. Future Developments Intrathecal chemotherapy for neoplastic meningitis may be a worthwhile option for a number of patients with this very serious disease. Technological developments allowing slow-release delivery of potentially active drugs may in the Inhibitors,research,lifescience,medical future be combined with targeted treatments (monoclonal antibodies, small molecule inhibitors) focused

on multistep inhibition of neoplastic cell survival, growth, and spreading within the neuraxis. However, a better basic knowledge of the biological mechanisms Inhibitors,research,lifescience,medical underlying selective homing of neoplastic cells to the leptomeninges, together with strict monitoring of the risk/benefit ratio [20, 21], will be needed before routine adoption of these approaches becomes a standard of care. This is very important, Inhibitors,research,lifescience,medical since increased

survival times are (also) the consequence of more aggressive systemic treatments, which may significantly enhance the neurotoxicity of intrathecal therapies [22–24].
Glioblastoma is one of the most malignant and consistently fatal brain cancers in adults. Treatment of glioma remains a challenge largely because of its rapid growth rate and the highly invasive nature of this disease, despite incremental advances in surgical and radiation therapies [1]. Glioma cells are considered to require the activation of matrix metalloproteinase (MMP)-2, which degrades the extracellular matrix (ECM) else during invasion and migration [2, 3]. In the central nervous system, membrane type MMP-1 (MT1-MMP) has a more important role than MMP-2 during ECM remodeling, migration, infiltration, and invasion of gliomas [4]. MT1-MMP on cell surfaces is replenished by autodegradation or clathrin-dependent internalization, and its concentration is stabilized by the tissue inhibitor of MMP (TIMP)-2 [5, 6]. Malignant human gliomas express membrane-anchored MMPs and their endogenous TIMPs [7–10].