Novel drug delivery strategies in neuro-oncology.
Treatment of malignant gliomas represents one of the most formidable challenges in oncology. Despite treatment with surgery, radiation therapy, and chemotherapy, the prognosis remains poor, particularly for glioblastoma, which has a median survival of 12 to 15 months. An important impediment to finding effective treatments for malignant gliomas is the presence of the blood brain barrier, which serves to prevent delivery of potentially active therapeutic compounds. Multiple efforts are focused on developing strategies to effectively deliver active drugs to brain tumor cells. Blood brain barrier disruption and convection-enhanced delivery have emerged as leading investigational delivery techniques for the treatment of malignant brain tumors. Clinical trials using these methods have been completed, with mixed results, and several more are being initiated. In this review, we describe the clinically available methods used to circumvent the blood brain barrier and summarize the results to date of ongoing and completed clinical trials.
Bidros
Dani S
DS
Department of Neurological Surgery, Brain Tumor and NeuroOncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Vogelbaum
Michael A
MA
D000818:Animals; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001812:Blood-Brain Barrier / Q000187:drug effects / Q000503:physiopathology; D001921:Brain / Q000098:blood supply / Q000187:drug effects; D001932:Brain Neoplasms / Q000188:drug therapy*; D002404:Catheterization / Q000295:instrumentation / Q000379:methods; D016503:Drug Delivery Systems / Q000379:methods*; D004343:Drug Implants; D005098:Exotoxins / Q000008:administration & dosage; D005822:Genetic Vectors; D005909:Glioblastoma / Q000188:drug therapy; D005910:Glioma / Q000188:drug therapy*; D006801:Humans; D000922:Immunotoxins / Q000008:administration & dosage; D007378:Interleukins / Q000008:administration & dosage; D014168:Transferrin / Q000008:administration & dosage; D016211:Transforming Growth Factor alpha / Q000008:administration & dosage; D016212:Transforming Growth Factor beta / Q000008:administration & dosage; D014464:Ultrasonic Therapy / Q000379:methods; D000097668:Pseudomonas aeruginosa Exotoxin A
D000970:Antineoplastic Agents; D004343:Drug Implants; D005098:Exotoxins; D000922:Immunotoxins; D007378:Interleukins; D014168:Transferrin; D016211:Transforming Growth Factor alpha; D016212:Transforming Growth Factor beta; C529632:transforming growth factor(alpha)-Pseudomonas aeruginosa exotoxin (38); D000097668:Pseudomonas aeruginosa Exotoxin A