Why cerebellar glioblastoma is rare and how that indicates adjunctive use of the FDA-approved anti-emetic aprepitant might retar

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Clin Transl Oncol. 2009 Jul;11(7):408-10.

Why cerebellar glioblastoma is rare and how that indicates adjunctive use of the FDA-approved anti-emetic aprepitant might retard cerebral glioblastoma growth: a new hypothesis to an old question.

Several lines of evidence point to SP signalling as an ini-
tiating and growth-enhancing path in glioblastomas. The
paucity of primary cerebellar glioblastoma may refl
ect this
given the absence of SP signalling in the normal adult cere-
bellum. Aprepitant is a well tolerated SP inhibitor marketed
to treat nausea. Given the eminently benign side-effect pro-
fi
le of aprepitant and the reliably malignant course of glio-
blastoma, the risk/benefi
t ratio strongly favours a clinical
trial of chronic adjunctive aprepitant during active standard
chemotherapy and radiation treatment.
The poor prognosis and fl orid neurochemical synthe-
sising and utilising nature of glioblastoma, particularly its
cancer stem cell sub-population [34, 35], demands a wider,
more comprehensive attack than is currently practised [36].
To further this end, comprehensive growth factor blocking
and a multimodal approach should be explored as per the
recent trenchant advocacy by Lefranc [36]. Since many
of the growth-enhancing signalling systems operative in
glioblastoma intersect with each other and therefore can
cross-cover [37, 38], they all must be blocked or thwarted
for cure. This current short note supports that contention
and suggests a small fi rst step to that end by blocking SP

signalling by using aprepitent