Patient with recurrent grade 4 astrocytoma responding favorably to intranasal delivery of NEO100, highly pure perillyl alcohol: illustrative case.

in Journal of neurosurgery. Case lessons by Axel H Schönthal, Stephen Swenson, Frank M Senecal, Rhonda Mittenzwei, John L Go, Thomas C Chen

TLDR

  • A 40-year-old woman with recurrent glioma was treated with NEO100 via intranasal delivery, resulting in striking tumor regression and improved quality of life.
  • The study suggests that NEO100 may be a promising novel approach to the treatment of recurrent glioma, providing an alternative to traditional chemotherapy.
  • Further studies are needed to evaluate the safety and efficacy of IN NEO100 therapy.

Abstract

Better treatments are needed for patients with grade 4 gliomas, especially in the setting of recurrence. The authors are developing NEO100, a clinical-grade version of the natural monoterpene perillyl alcohol, as a cancer therapeutic to be administered via intranasal (IN) delivery to patients with recurrent glioma. A 40-year-old woman was diagnosed with an isocitrate dehydrogenase 1-mutant, CNS WHO grade 4 astrocytoma harboring an unmethylated MGMT promoter. She underwent surgery and standard chemoradiation treatment with temozolomide (TMZ), but after 6 cycles of adjuvant TMZ, the tumor recurred. The patient was started on daily IN NEO100 at 288 mg 4 times a day, administered using a nebulizer and nasal mask. Routine MRI revealed steady tumor regression over the course of 13 months of daily IN NEO100, to the point where the tumor became inconspicuous. There were no serious adverse events, and her quality of life improved and remained high. The authors present a case in which IN cancer therapy with NEO100 was well tolerated and was associated with striking tumor regression, providing further evidence that this novel conceptual approach to cancer therapy might become useful for the improved treatment of recurrent glioma. https://thejns.org/doi/10.3171/CASE24683.

Overview

  • The study presents a case of a 40-year-old woman with recurrent isocitrate dehydrogenase 1-mutant, CNS WHO grade 4 astrocytoma who was treated with NEO100, a clinical-grade version of perillyl alcohol, via intranasal delivery.
  • The patient underwent surgery and standard chemoradiation treatment with temozolomide, but the tumor recurred after 6 cycles of adjuvant TMZ.
  • The patient was started on daily IN NEO100 at 288 mg 4 times a day, which resulted in steady tumor regression over 13 months with no serious adverse events and improved quality of life.

Comparative Analysis & Findings

  • The case study demonstrates that IN NEO100 therapy was well tolerated and associated with striking tumor regression in a patient with recurrent glioma.
  • The study suggests that NEO100 may be a promising novel approach to the treatment of recurrent glioma, providing an alternative to traditional chemotherapy.
  • The results of this case study provide further evidence that IN NEO100 therapy may be a useful treatment option for patients with recurrent glioma.

Implications and Future Directions

  • The study highlights the potential of NEO100 as a promising novel approach to the treatment of recurrent glioma, providing an alternative to traditional chemotherapy.
  • Future studies are needed to further evaluate the safety and efficacy of IN NEO100 therapy in larger patient populations.
  • Additional research is required to explore the feasibility and potential benefits of NEO100 as a treatment option for patients with recurrent glioma.
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