title: New therapeutic strategies regarding endovascular treatment of glioblastoma, the role of the blood-brain barrier and new ways to bypass it.
abstract: The treatment protocols for glioblastoma multiforme (GBM) involve a combination of surgery, radiotherapy and adjuvant chemotherapy. Despite this multimodal approach, the prognosis of patients with GBM remains poor and there is an urgent need to develop novel strategies to improve quality of life and survival in this population. In an effort to improve outcomes, intra-arterial drug delivery has been used in many recent clinical trials; however, their results have been conflicting. The blood-brain barrier (BBB) is the major obstacle preventing adequate concentrations of chemotherapy agents being reached in tumor tissue, regardless of the method of delivering the drugs. Therapeutic failures have often been attributed to an inability of drugs to cross the BBB. However, during the last decade, a better understanding of BBB physiology along with the development of new technologies has led to innovative methods to circumvent this barrier. This paper focuses on strategies and techniques used to bypass the BBB already tested in clinical trials in humans and also those in their preclinical stage. We also discuss future therapeutic scenarios, including endovascular treatment combined with BBB disruption techniques, for patients with GBM.
authors.affiliation: Department of Neurology and Psychiatry, Endovascular Neurosurgery/Interventional Neuroradiology, 'Sapienza' University of Rome, Rome, Italy.
authors.forename: S
authors.identifier: http://orcid.org/0000-0002-3920-8517
authors.initials: S
authors.lastname: Peschillo
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Caporlingua
authors.affiliation: Department of Radiology, 'Sapienza' University of Rome, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Diana
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Caporlingua
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Delfini
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001812:Blood-Brain Barrier / Q000503:physiopathology*; D001932:Brain Neoplasms / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery*; D016503:Drug Delivery Systems; D057510:Endovascular Procedures / Q000379:methods*; D005909:Glioblastoma / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans
chemical_list: D000970:Antineoplastic Agents
keywords: Brain; Drug; Intervention; Malignant; Tumor