Title:Convection-Enhanced Delivery for Diffuse Intrinsic Pontine Glioma Treatment
Volume: 15
Issue: 1
Author(s): Zhiping Zhou, Ranjodh Singh and Mark M. Souweidane
Affiliation:
Keywords:
Catheter design, convection-enhanced delivery, diffuse intrinsic pontine glioma, drug distribution.
Abstract: Convection-enhanced delivery (CED) is a technique designed to deliver
drugs directly into the brain or tumors. Its ability to bypass the blood-brain barrier
(BBB), one of the major hurdles in delivering drugs to the brain, has made it a
promising drug delivery method for the treatment of primary brain tumors. A number
of clinical trials utilizing CED of various therapeutic agents have been conducted to
treat patients with supratentorial high-grade gliomas. Significant responses have been
observed in certain patients in all of these trials. However, the insufficient ability to
monitor drug distribution and pharmacokinetics hampers CED from achieving its
potentials on a larger scale. Brainstem CED for diffuse intrinsic pontine glioma
(DIPG) treatment is appealing because this tumor is compact and has no definitive
treatment. The safety of brainstem CED has been established in small and large animals, and recently in
early stage clinical trials. There are a few current clinical trials of brainstem CED in treating DIPG patients
using targeted macromolecules such as antibodies and immunotoxins. Future advances for CED in DIPG
treatment will come from several directions including: choosing the right agents for infusion; developing
better agents and regimen for DIPG infusion; improving instruments and technique for easier and accurate
surgical targeting and for allowing multisession or prolonged infusion to implement optimal time sequence;
and better understanding and control of drug distribution, clearance and time sequence. CED-based
therapies for DIPG will continue to evolve with new understanding of the technique and the disease.
