Intra-Arterial Chemotherapy for Malignant Gliomas: A Critical Analysis

Abstract

<jats:p> Intra-arterial (IA) chemotherapy for malignant gliomas including glioblastoma multiforme was initiated decades ago, with many preclinical and clinical studies having been performed since then. Although novel endovascular devices and techniques such as microcatheter or balloon assistance have been introduced into clinical practice, the question remains whether IA therapy is safe and superior to other drug delivery modalities such as intravenous (IV) or oral treatment regimens. This review focuses on IA delivery and surveys the available literature to assess the advantages and disadvantages of IA chemotherapy for treatment of malignant gliomas. In addition, we introduce our hypothesis of using IA delivery to selectively target cancer stem cells residing in the perivascular stem cell niche. </jats:p>

Orthotopic glioblastoma stem-like cell xenograft model in mice to evaluate intra-arterial delivery of bevacizumab: From bedside to bench

“…16 IA chemotherapy to target brain tumors has been studied widely in preclinical and clinical trials and shows some promising results. 5 For instance, in patients with retinoblastoma or lymphoma, IA delivery of chemotherapy has been reported to improve patient outcome. 8,9 For malignant gliomas various agents, including nitrosurea and platinum derivatives, have been tested within the last decades, but the efficacy of these IA agents needs further assessment.…”

“…8,9 For malignant gliomas various agents, including nitrosurea and platinum derivatives, have been tested within the last decades, but the efficacy of these IA agents needs further assessment. 5,6 Recently IA delivery of agents, including the humanized antibody BV, have been initiated in human clinical trials, with a favorable safety profile. 7,27, 28 We report a xenograft mouse model that allows us to study IA BV treatment for GBM.…”

“…[1][2][3] Despite trimodal therapy -with surgery, radiation therapy and chemotherapy with temozolomide -patients have a dismal prognosis with a 5-year overall survival rate of approximately 10%. 3,4 Superselective intra-arterial cerebral infusion (SIACI) chemotherapy achieves a high drug concentration in the tumor supplying vessels while minimizing systemic side effects 1,2,[5][6][7][8][9] ; however, these data are still under investigation in GBM trials in humans.…”

Diffusion Efficiency and Bioavailability of Resveratrol Administered to Rat Brain by Different Routes: Therapeutic Implications

“…Interventional therapy has been used in the treatment of human brain malignancies to reduce systemic side-effects, to avoid rapid drug metabolism and to prevent recurrence [12].…”

Short-Term Clinico-Radiographic Response to Super-Selective Intra-Arterial Cerebral Infusion of Bevacizumab for the Treatment of Vestibular Schwannomas in Neurofibromatosis Type 2

“…We had no thromboembolic events, hemorrhage, congestive heart failure, gastrointestinal perforation, or delayed wound healing after IA BV treatment. The use of intra-arterial delivery of chemotherapy has been shown to be advantageous to IV dosing in cerebral disease in both animal models of glioma and human studies 16 . In addition, techniques for BTB disruption with osmotic agents have been developed and safely utilized with chemotherapy infusion for over 20 years.…”