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Review
. 2020 Apr;147(2):261-278.
doi: 10.1007/s11060-020-03435-6. Epub 2020 Feb 19.

Super selective intra-arterial cerebral infusion of modern chemotherapeutics after blood-brain barrier disruption: where are we now, and where we are going

Randy S D'Amico  1 , Deepak Khatri  2 , Noah Reichman  2 , Nitesh V Patel  2 , Tamika Wong  2 , Sherese R Fralin  2 , Mona Li  2 , Jason A Ellis  2 , Rafael Ortiz  2 , David J Langer  2 , John A Boockvar  2
Affiliations
Review

Super selective intra-arterial cerebral infusion of modern chemotherapeutics after blood-brain barrier disruption: where are we now, and where we are going

Randy S D'Amico et al. J Neurooncol. 2020 Apr.

Erratum in

Abstract

Introduction: Intra-arterial (IA) delivery of therapeutic agents across the blood-brain barrier (BBB) is an evolving strategy which enables the distribution of high concentration therapeutics through a targeted vascular territory, while potentially limiting systemic toxicity. Studies have demonstrated IA methods to be safe and efficacious for a variety of therapeutics. However, further characterization of the clinical efficacy of IA therapy for the treatment of brain tumors and refinement of its potential applications are necessary.

Methods: We have reviewed the preclinical and clinical evidence supporting superselective intraarterial cerebral infusion (SSIACI) with BBB disruption for the treatment of brain tumors. In addition, we review ongoing clinical trials expanding the applicability and investigating the efficacy of IA therapy for the treatment of brain tumors.

Results: Trends in recent studies have embraced the use of SSIACI and less neurotoxic chemotherapies. The majority of trials continue to use mannitol as the preferred method of hyperosmolar BBB disruption. Recent preclinical and preliminary human investigations into the IA delivery of Bevacizumab have demonstrated its safety and efficacy as an anti-tumor agent both alone and in combination with chemotherapy.

Conclusion: IA drug delivery may significantly affect the way treatments are delivered to patients with brain tumors, and in particular GBM. With refinement and standardization of the techniques of IA drug delivery, improved drug selection and formulations, and the development of methods to minimize treatment-related neurological injury, IA therapy may offer significant benefits for the treatment of brain tumors.

Keywords: Blood–brain barrier; Brain tumor; Chemotherapy; Glioblastoma; Glioma; High-grade glioma; Intra-arterial infusion.

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