Polifeprosan 20 with carmustine (GLIADEL®)
polymer implant wafer is a biodegradable compound containing 3.85%
carmustine (
BCNU, bischloroethylnitrosourea) implanted in the brain at the time of planned
tumor surgery, which then slowly degrades to release the
BCNU chemotherapy directly into the brain thereby bypassing the blood-brain barrier.
Carmustine implant wafers were demonstrated to improve survival in randomized placebo-controlled trials in patients undergoing a near total resection of newly diagnosed or recurrent
malignant glioma. Based on these trials and other supporting data,
carmustine wafer
therapy was approved for use for newly diagnosed and recurrent
malignant glioma in the United States and the European Union. Adverse events are uncommon, and as this
therapy is placed at the time of surgery, it does not add to patient treatment burden. Nevertheless, this
therapy appears to be underutilized. This article reviews the evidence for a favorable therapeutic ratio for the patient and the potential barriers. Consideration of these issues is important for optimal use of this therapeutic approach and may be important as this technology and other local
therapies are further developed in the future.