Safety and maximum tolerated dose of superselective intraarterial cerebral infusion of bevacizumab after osmotic blood-brain barrier disruption for recurrent malignant glioma. Clinical article.
OBJECTIVE
The authors assessed the safety and maximum tolerated dose of superselective intraarterial cerebral infusion (SIACI) of bevacizumab after osmotic disruption of the blood-brain barrier (BBB) with mannitol in patients with recurrent malignant glioma.


METHODS
A total of 30 patients with recurrent malignant glioma were included in the current study.


RESULTS
The authors report no dose-limiting toxicity from a single dose of SIACI of bevacizumab up to 15 mg/kg after osmotic BBB disruption with mannitol. Two groups of patients were studied; those without prior bevacizumab exposure (naïve patients; Group I) and those who had received previous intravenous bevacizumab (exposed patients; Group II). Radiographic changes demonstrated on MR imaging were assessed at 1 month postprocedure. In Group I patients, MR imaging at 1 month showed a median reduction in the area of tumor enhancement of 34.7%, a median reduction in the volume of tumor enhancement of 46.9%, a median MR perfusion (MRP) reduction of 32.14%, and a T2-weighted/FLAIR signal decrease in 9 (47.4%) of 19 patients. In Group II patients, MR imaging at 1 month showed a median reduction in the area of tumor enhancement of 15.2%, a median volume reduction of 8.3%, a median MRP reduction of 25.5%, and a T2-weighted FLAIR decrease in 0 (0%) of 11 patients.


CONCLUSIONS
The authors conclude that SIACI of mannitol followed by bevacizumab (up to 15 mg/kg) for recurrent malignant glioma is safe and well tolerated. Magnetic resonance imaging shows that SIACI treatment with bevacizumab can lead to reduction in tumor area, volume, perfusion, and T2-weighted/FLAIR signal.
Departments of Neurosurgery, Weill Medical College of Cornell University, 510 East 70th Street, New York, New York 10021, USA. jab2029@med.cornell.edu
John A
JA
Boockvar
Apostolos J
AJ
Tsiouris
Christoph P
CP
Hofstetter
Ilhami
I
Kovanlikaya
Sherese
S
Fralin
Kartik
K
Kesavabhotla
Stephen M
SM
Seedial
Susan C
SC
Pannullo
Theodore H
TH
Schwartz
Philip
P
Stieg
Robert D
RD
Zimmerman
Jared
J
Knopman
Ronald J
RJ
Scheff
Paul
P
Christos
Shankar
S
Vallabhajosula
Howard A
HA
Riina
D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D001812:Blood-Brain Barrier / Q000187:drug effects*; D001921:Brain / Q000473:pathology; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000473:pathology; D002536:Cerebral Arteries; D004232:Diuretics / Q000494:pharmacology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008353:Mannitol / Q000494:pharmacology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016896:Treatment Outcome
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D004232:Diuretics; D000068258:Bevacizumab; D008353:Mannitol