Brain Tumour Survivor

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 Post subject: Gliadel
PostPosted: Fri Sep 23, 2005 11:05 pm 

This is some basic information about the Gliadel wafers which I obtained after the subject was raised on the OzBt discussion list.


Denis Strangman
Gliadel should be stored at below –18 degrees C. Transport internationally and within Australia occurs on dry-ice, which sublimes at –78.50 degrees Celsius. Hence Gliadel can be stored, transported and delivered to theatre within the specified storage conditions for the product. Alternatively, the hospital can store Gliadel on site – a situation more likely with increased usage and price-reimbursement. A treatment pack of Gliadel currently costs $16,000. Orphan Australia, the Sponsor/pharmaceutical company, has submitted an application for price-reimbursement to the Australian authorities, an outcome should be known toward the end of the year
Carmustine and temozolomide (TMZ) are different molecules but both are alkylating agents
Gliadel is inserted locally, at the tumour site, and acts locally. Carmustine from Gliadel does not penetrate systemically to any significant extent and is in fact kept within the site by virtue of the surrounding brain tissue. This means that carmustine from the Gliadel does not go into the systemic circulation to any appreciable extent and therefore has a decreased potential to cause systemic side-effects.
TMZ is not a local therapy. It is an oral agent that is absorbed into the systemic circulation and also crosses the blood-brain barrier. This means that TMZ can exert its effect within the resected cavity and on residual tumour (as is the case for Gliadel) but it may also exert an effect systemically in the form of side-effects elsewhere throughout the body.
(It’s also worth noting that carmustine (not Gliadel) can be given intravenously (systemically) for the treatment of gliomas. In this setting higher doses are used in order to penetrate the blood -brain barrier. By virtue of these high doses, the side-effects are higher. Gliadel was developed to avoid this problem.)
A neurosurgeon only will implant Gliadel, and generally an oncologist, neuro-oncologist or similar clinician will prescribe TMZ. Also, as has been the case in Australia, oncologists, neuro-oncologists or similar clinicians may also recommend Gliadel to the neurosurgeon for use in a given patient instead of TMZ. The reasons for this may vary according to the patient’s history, diagnosis etc. Likewise a neurosurgeon may recommend that Glaidel is not appropriate for a particular patient.

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