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Review
Advances in endovascular neuro-oncology: endovascular selective intra-arterial (ESIA) infusion of targeted biologic therapy for brain tumors
  1. Visish M Srinivasan1,
  2. Frederick F Lang2,
  3. Stephen R Chen3,4,
  4. Melissa M Chen4,
  5. Joy Gumin2,
  6. Jeremiah Johnson1,
  7. Jan-Karl Burkhardt1,
  8. Peter Kan1
  1. 1 Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
  2. 2 Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  3. 3 Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
  4. 4 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr Peter Kan, Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA; peter.kan{at}bcm.edu

Abstract

Background Malignant gliomas continue to have a poor clinical outcome with available therapies. In the past few years, new targeted biologic therapies have been studied, with promising results. However, owing to problems with ineffective IV delivery of these newer agents, an alternative, more direct delivery mechanism is needed. Simultaneously, advancements in neuroendovascular technology have allowed endovascular selective intra-arterial approaches to delivery. This method has the potential to increase drug delivery and selectively target tumor vasculature.

Objective To review the history of IA therapy for brain tumors, prior failures and successes, the emergence of new technologies and therapies, and the future direction of this young field.

Methods A comprehensive literature search of two databases (PubMed, Ovid Medline) was performed for several terms including ‘brain tumor’, ‘glioma’, and ‘endovascular intra-arterial’. Forty-five relevant articles were identified via a systematic review following PRISMA guidelines. Additional relevant articles were selected for further in-depth review. Emphasis was given to articles discussing selective intra-arterial intracranial delivery using microcatheters.

Results Endovascular intra-arterial therapy with chemotherapy has had mixed results, with currently active trials using temozolomide, cetuximab, and bevacizumab. Prior attempts at IA chemotherapy with older-generation medications did not surpass the efficacy of IV administration. Advances in neuro-oncology have brought to the forefront new targeted biologic therapies.

Conclusions In this review, we discuss the emerging field of endovascular neuro-oncology, a field that applies modern neuroendovascular techniques to the delivery of new therapeutic agents to brain tumors. The development of targeted therapies for brain tumors has been concurrent with the development of microcatheter technology, which has made superselective distal intracranial arterial access feasible and safe.

  • brain tumor
  • chemotherapy
  • delivery
  • endovascular
  • glioma
  • selective
  • superselective
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Footnotes

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  • Contributors Contributorship: Conception and design: PK, VS, FFL. Acquisition of data; analysis and interpretation of data; drafting the article, critically revising the article, and review of the submitted version of the manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: VS. Study supervision: PK, FFL

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests PK is a consultant for Stryker and Cerenovus; FFL is a patent holder for Delta-24-RGD, a viral agent we discuss in our manuscript.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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