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Ruan J, Shi Y, Luo P, Li L, Huang J, Chen J, Yang H. Safety and feasibility of intra-arterial delivery of teniposide to high grade gliomas after blood-brain barrier disruption: a case series. J Neurointerv Surg 2023:jnis-2023-021055. [PMID: 38071559 DOI: 10.1136/jnis-2023-021055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/11/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND This case series describes the safety and efficacy of superselective intra-arterial (IA) cerebral infusion of teniposide for the treatment of patients with glioma, to provide new ideas and methods for the treatment of high grade gliomas. METHODS 12 patients with glioma who were previously treated with standard therapy were treated with superselective IA cerebral infusion of teniposide. Patients received at least two cycles of treatment (one cycle: 150 mg/time, used for 1 day, repeated at 28 day intervals) after blood-brain barrier disruption. Patients received individualized treatment on the tumor location. The ophthalmic artery was bypassed during the super-selective arterial infusion. RESULTS No significant differences in biochemical indexes and Karnofsky performance status (KPS) score were observed before and after treatment, and no evident adverse events occurred (P>0.05). In a recent response evaluation (August 2023), two (8%) patients presented with a complete response (16.7%), four had a partial response (33.3%), four had stable disease (33.3%), and two showed progressive disease (16.7%). The overall response rate and disease control rate were 50.0% and 83.3%, respectively. In addition, we described the detailed course of treatment in two patients. Case No 1 (recurrent tumor) and case No 2 (primary tumor) received six and three cycles of teniposide infusion, respectively. After treatment, the tumors of the patients were significantly reduced without evident adverse effects. CONCLUSION This small series suggests that superselective IA cerebral infusion of teniposide may be a safe and effective therapy in the multimodal treatment of malignant glioma and warrants further study in larger prospective investigations.
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Affiliation(s)
- Jian Ruan
- Department of Neuro-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - You Shi
- Department of Neuro-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Pengren Luo
- Department of Neuro-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Lin Li
- Department of Neuro-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Jiashang Huang
- Department of Neuro-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Jie Chen
- Department of Neuro-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Haifeng Yang
- Department of Neuro-Oncology, Chongqing University Cancer Hospital, Chongqing, China
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Vallejo FA, Sigdel G, Veliz EA, Leblanc RM, Vanni S, Graham RM. Carbon Dots in Treatment of Pediatric Brain Tumors: Past, Present, and Future Directions. Int J Mol Sci 2023; 24:ijms24119562. [PMID: 37298513 DOI: 10.3390/ijms24119562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023] Open
Abstract
Pediatric brain tumors remain a significant source of morbidity and mortality. Though developments have been made in treating these malignancies, the blood-brain barrier, intra- and inter-tumoral heterogeneity, and therapeutic toxicity pose challenges to improving outcomes. Varying types of nanoparticles, including metallic, organic, and micellar molecules of varying structures and compositions, have been investigated as a potential therapy to circumvent some of these inherent challenges. Carbon dots (CDs) have recently gained popularity as a novel nanoparticle with theranostic properties. This carbon-based modality is highly modifiable, allowing for conjugation to drugs, as well as tumor-specific ligands in an effort to more effectively target cancerous cells and reduce peripheral toxicity. CDs are being studied pre-clinically. The ClinicalTrials.gov site was queried using the search terms: brain tumor and nanoparticle, liposome, micelle, dendrimer, quantum dot, or carbon dot. At the time of this review, 36 studies were found, 6 of which included pediatric patients. Two of the six studies investigated nanoparticle drug formulations, whereas the other four studies were on varying liposomal nanoparticle formulations for the treatment of pediatric brain tumors. Here, we reviewed the context of CDs within the broader realm of nanoparticles, their development, promising pre-clinical potential, and proposed future translational utility.
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Affiliation(s)
- Frederic A Vallejo
- Department of Neurosurgery, Miller School of Medicine, University of Miami, 1095 NW 14th Terrace, Miami, FL 33136, USA
| | - Ganesh Sigdel
- Department of Chemistry, University of Miami, 1301 Memorial Drive, Coral Gables, FL 33146, USA
| | - Eduardo A Veliz
- Department of Chemistry, University of Miami, 1301 Memorial Drive, Coral Gables, FL 33146, USA
| | - Roger M Leblanc
- Department of Chemistry, University of Miami, 1301 Memorial Drive, Coral Gables, FL 33146, USA
| | - Steven Vanni
- Department of Neurosurgery, Miller School of Medicine, University of Miami, 1095 NW 14th Terrace, Miami, FL 33136, USA
- HCA Florida University Hospital, 3476 S University Dr., Davie, FL 33328, USA
- Department of Medicine, Dr. Kiran C. Patel College of Allopathic Medicine, Davie, FL 33328, USA
| | - Regina M Graham
- Department of Neurosurgery, Miller School of Medicine, University of Miami, 1095 NW 14th Terrace, Miami, FL 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL 33136, USA
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Uluc K, Neuwelt EA, Ambady P. Advances in Intraarterial Chemotherapy Delivery Strategies and Blood-Brain Barrier Disruption. Neurosurg Clin N Am 2022; 33:219-223. [PMID: 35346454 DOI: 10.1016/j.nec.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Chemotherapeutics play a significant role in the management of most brain tumors. First pass effect, systemic toxicity, and more importantly, the blood-brain barrier pose significant challenges to the success of chemotherapy. Over the last 80 years, different techniques of intraarterial chemotherapy delivery have been performed in many studies but failed to become standard of care. The purpose of this article is to review the history of intraarterial drug delivery and osmotic blood-brain barrier disruption, identify the challenges for clinical translation, and identify future directions for these approaches.
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Affiliation(s)
- Kutluay Uluc
- Neurosurgery, Northernlight Eastern Maine Medical Center, Bangor, ME, USA
| | - Edward A Neuwelt
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA; Department of Neurosurgery, Oregon Health & Science University, Portland, OR, USA; Portland Veterans Affairs Medical Center, Portland, OR, USA
| | - Prakash Ambady
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA.
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Uluc K, Ambady P, McIntyre MK, Tabb JP, Kersch CN, Nerison CS, Huddleston A, Liu JJ, Dogan A, Priest RA, Fu R, Prola Netto J, Siler DA, Muldoon LL, Gahramanov S, Neuwelt EA. Safety of intra-arterial chemotherapy with or without osmotic blood–brain barrier disruption for the treatment of patients with brain tumors. Neurooncol Adv 2022; 4:vdac104. [PMID: 35892048 PMCID: PMC9307096 DOI: 10.1093/noajnl/vdac104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Intra-arterial administration of chemotherapy with or without osmotic blood–brain barrier disruption enhances delivery of therapeutic agents to brain tumors. The aim of this study is to evaluate the safety of these procedures. Methods Retrospectively collected data from a prospective database of consecutive patients with primary and metastatic brain tumors who received intra-arterial chemotherapy without osmotic blood–brain barrier disruption (IA) or intra-arterial chemotherapy with osmotic blood–brain barrier disruption (IA/OBBBD) at Oregon Health and Science University (OHSU) between December 1997 and November 2018 is reported. Chemotherapy-related complications are detailed per Common Terminology Criteria for Adverse Events (CTCAE) guidelines. Procedure-related complications are grouped as major and minor. Results 4939 procedures (1102 IA; 3837 IA/OBBBD) were performed on 436 patients with various pathologies (primary central nervous system lymphoma [26.4%], glioblastoma [18.1%], and oligodendroglioma [14.7%]). Major procedure-related complications (IA: 12, 1%; IA/OBBBD: 27, 0.7%; P = .292) occurred in 39 procedures including 3 arterial dissections requiring intervention, 21 symptomatic strokes, 3 myocardial infarctions, 6 cervical cord injuries, and 6 deaths within 3 days. Minor procedure-related complications occurred in 330 procedures (IA: 41, 3.7%; IA/OBBBD: 289, 7.5%; P = .001). Chemotherapy-related complications with a CTCAE attribution and grade higher than 3 was seen in 359 (82.3%) patients. Conclusions We provide safety and tolerability data from the largest cohort of consecutive patients who received IA or IA/OBBBD. Our data demonstrate that IA or IA/OBBBD safely enhance drug delivery to brain tumors and brain around the tumor.
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Affiliation(s)
- Kutluay Uluc
- Department of Neurology, Oregon Health & Science University , Portland, Oregon , USA
| | - Prakash Ambady
- Department of Neurology, Oregon Health & Science University , Portland, Oregon , USA
| | - Matthew K McIntyre
- Department of Neurosurgery, Oregon Health & Science University , Portland, Oregon , USA
| | - John Philip Tabb
- Department of Neurosurgery, Oregon Health & Science University , Portland, Oregon , USA
| | - Cymon N Kersch
- Department of Neurology, Oregon Health & Science University , Portland, Oregon , USA
- Providence Portland Internal Medicine Residency Program , Providence, Portland, Oregon , USA
| | - Caleb S Nerison
- Western University of Health Sciences COMP-NW , Lebanon, Oregon , USA
| | - Amy Huddleston
- Department of Neurology, Oregon Health & Science University , Portland, Oregon , USA
| | - Jesse J Liu
- Department of Neurosurgery, Oregon Health & Science University , Portland, Oregon , USA
- Department of Interventional Radiology, Oregon Health & Science University , Portland, Oregon , USA
- Portland Veterans Affairs Medical Center , Portland, Oregon , USA
| | - Aclan Dogan
- Department of Neurosurgery, Oregon Health & Science University , Portland, Oregon , USA
| | - Ryan A Priest
- Department of Interventional Radiology, Oregon Health & Science University , Portland, Oregon , USA
| | - Rongwei Fu
- School of Public Health, Oregon Health & Science University , Portland, Oregon , USA
| | | | - Dominic A Siler
- Department of Neurosurgery, Oregon Health & Science University , Portland, Oregon , USA
| | - Leslie L Muldoon
- Department of Neurology, Oregon Health & Science University , Portland, Oregon , USA
| | - Seymur Gahramanov
- Capital Neurosurgery Specialists, Salem Health , Salem, Oregon , USA
| | - Edward A Neuwelt
- Department of Neurology, Oregon Health & Science University , Portland, Oregon , USA
- Department of Neurosurgery, Oregon Health & Science University , Portland, Oregon , USA
- Portland Veterans Affairs Medical Center , Portland, Oregon , USA
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Rechberger JS, Thiele F, Daniels DJ. Status Quo and Trends of Intra-Arterial Therapy for Brain Tumors: A Bibliometric and Clinical Trials Analysis. Pharmaceutics 2021; 13:pharmaceutics13111885. [PMID: 34834300 PMCID: PMC8625566 DOI: 10.3390/pharmaceutics13111885] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 12/13/2022] Open
Abstract
Intra-arterial drug delivery circumvents the first-pass effect and is believed to increase both efficacy and tolerability of primary and metastatic brain tumor therapy. The aim of this update is to report on pertinent articles and clinical trials to better understand the research landscape to date and future directions. Elsevier's Scopus and ClinicalTrials.gov databases were reviewed in August 2021 for all possible articles and clinical trials of intra-arterial drug injection as a treatment strategy for brain tumors. Entries were screened against predefined selection criteria and various parameters were summarized. Twenty clinical trials and 271 articles satisfied all inclusion criteria. In terms of articles, 201 (74%) were primarily clinical and 70 (26%) were basic science, published in a total of 120 different journals. Median values were: publication year, 1986 (range, 1962-2021); citation count, 15 (range, 0-607); number of authors, 5 (range, 1-18). Pertaining to clinical trials, 9 (45%) were phase 1 trials, with median expected start and completion years in 2011 (range, 1998-2019) and 2022 (range, 2008-2025), respectively. Only one (5%) trial has reported results to date. Glioma was the most common tumor indication reported in both articles (68%) and trials (75%). There were 215 (79%) articles investigating chemotherapy, while 13 (65%) trials evaluated targeted therapy. Transient blood-brain barrier disruption was the commonest strategy for articles (27%) and trials (60%) to optimize intra-arterial therapy. Articles and trials predominately originated in the United States (50% and 90%, respectively). In this bibliometric and clinical trials analysis, we discuss the current state and trends of intra-arterial therapy for brain tumors. Most articles were clinical, and traditional anti-cancer agents and drug delivery strategies were commonly studied. This was reflected in clinical trials, of which only a single study had reported outcomes. We anticipate future efforts to involve novel therapeutic and procedural strategies based on recent advances in the field.
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Affiliation(s)
- Julian S. Rechberger
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN 55905, USA
- Correspondence:
| | - Frederic Thiele
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA;
| | - David J. Daniels
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN 55905, USA
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Lukas RV. Commentary: Long-Term Outcomes of Intra-Arterial Chemotherapy for Progressive or Unresectable Pilocytic Astrocytomas: Case Studies. Neurosurgery 2021; 88:E343-E344. [PMID: 33548920 DOI: 10.1093/neuros/nyab009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/11/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rimas V Lukas
- Department of Neurology, Northwestern University, Chicago, Illinois, USA.,Lou & Jean Malnati Brain Tumor Institute, Northwestern University, Chicago, Illinois, USA
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