Convection-enhanced delivery for the treatment of glioblastoma
Convection-enhanced delivery for the treatment of glioblastoma
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DOI：
10.1093/neuonc/nou354
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发表时间：
2015-03-01
期刊：
影响因子：
15.9
通讯作者：
Aghi, Manish K.
中科院分区：
文献类型：
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作者：
Vogelbaum, Michael A.;Aghi, Manish K.
胶质母细胞瘤（GBM）的有效治疗仍然是一个艰巨的挑战。尽管数十年来对传统和新型生物靶向疗法进行了临床试验，但生存率仍然很低。有相当多的证据表明，当通过常规途径（静脉内或口服）给药时，这些治疗剂中的大多数不能到达其在大脑中的靶点。因此，将治疗剂直接递送至脑和脑肿瘤是一个活跃的研究领域。这些技术之一，对流增强递送（CED），涉及导管的植入，通过该导管，可以使用连续的低正压整体流动递送常规和新型治疗制剂。在临床前和临床环境中的研究已经证明，CED可以有效地将治疗剂递送到大量的脑和脑肿瘤。然而，导管技术和输送成像的局限性阻碍了该技术的可靠性和可重现性，并且唯一完成的GBM III期研究未显示通过CED输送试验性治疗药物的患者的生存获益。CED的进一步开发正在进行中，新的导管设计和成像方法可能使CED成为一种更有效的治疗输送技术。
Effective treatment of glioblastoma (GBM) remains a formidable challenge. Survival rates remain poor despite decades of clinical trials of conventional and novel, biologically targeted therapeutics. There is considerable evidence that most of these therapeutics do not reach their targets in the brain when administered via conventional routes (intravenous or oral). Hence, direct delivery of therapeutics to the brain and to brain tumors is an active area of investigation. One of these techniques, convection-enhanced delivery (CED), involves the implantation of catheters through which conventional and novel therapeutic formulations can be delivered using continuous, low-positive-pressure bulk flow. Investigation in preclinical and clinical settings has demonstrated that CED can produce effective delivery of therapeutics to substantial volumes of brain and brain tumor. However, limitations in catheter technology and imaging of delivery have prevented this technique from being reliable and reproducible, and the only completed phase III study in GBM did not show a survival benefit for patients treated with an investigational therapeutic delivered via CED. Further development of CED is ongoing, with novel catheter designs and imaging approaches that may allow CED to become a more effective therapeutic delivery technique.