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First-in-human real-time MRI guided intra-arterial delivery of drug in patient with brain tumor
EANS Academy. Kostyra K. Sep 26, 2019; 276051; EP03107
Abstract
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Background: Technological advancements in device and catheter design have fueled an explosive growth in the field of neurointervention. The intra-arterial route provides a minimally invasive path for the treatment of various cerebrovascular disorders including aneurysms, high flow vascular malformations, and acute stroke. Regarding oncologic processes, intra-arterial drug delivery to the central nervous system has been attempted since the 1960s, yet complications and highly variable results have limited its widespread adoption. More recently, the success of intra-arterial chemotherapy for the treatment of retinoblastoma along with the aforementioned technological advancements have revived interest in this approach for the treatment of primary brain tumors. Mannitol-mediated blood brain barrier (BBB) opening followed by intra-arterial bevacizumab has been shown to be safe and at least as effective as intravenous administration at a fraction of the systemic adverse effects. In one patient, intra-arterial bevacuzimab was successful in treating two consecutive glioblastoma recurrences leading to long-term survival.
Methods: We present the first-in-human application of real-time MRI guidance for intra-arterial therapeutic agent infusion to the brain while targeting a recurrent glioblastoma. Digital subtraction angiography failed to characterize the tumor angioarchitecture, showing faint to no distinct tumoral blush. The right posterior cerebral artery contributors were indistinct on DSA and real-time MRI during intra-arterial microcatheter infusion of gadolinium documented the potential biodistribution of the agent and its overlap with tumor and adjacent brain volumes. Real-time MRI during intra-arterial infusion enabled the modification of parameters and the determination of the subsequent drug infusion rate, adding precision to intra-arterial drug delivery.
Conclussions: Intra-arterial infusion of bevacizumab after BBB disruption may provide symptom relief and initial efficacy in patients with recurrent glioblastoma. The application of real-time MRI guidance aided in the precision of the procedure and may further improve treatment outcomes of this deadly disease.
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