Title | Safety and maximum tolerated dose of superselective intraarterial cerebral infusion of bevacizumab after osmotic blood-brain barrier disruption for recurrent malignant glioma. Clinical article. |
Publication Type | Journal Article |
Year of Publication | 2011 |
Authors | Boockvar JA, Tsiouris AJ, Hofstetter CP, Kovanlikaya I, Fralin S, Kesavabhotla K, Seedial SM, Pannullo SC, Schwartz TH, Stieg P, Zimmerman RD, Knopman J, Scheff RJ, Christos P, Vallabhajosula S, Riina HA |
Journal | J Neurosurg |
Volume | 114 |
Issue | 3 |
Pagination | 624-32 |
Date Published | 2011 Mar |
ISSN | 1933-0693 |
Keywords | Adult, Aged, Angiogenesis Inhibitors, Antibodies, Monoclonal, Antibodies, Monoclonal, Humanized, Bevacizumab, Blood-Brain Barrier, Brain, Brain Neoplasms, Cerebral Arteries, Diuretics, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Glioma, Humans, Injections, Intra-Arterial, Male, Mannitol, Middle Aged, Neoplasm Recurrence, Local, Treatment Outcome |
Abstract | OBJECT: 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. |
DOI | 10.3171/2010.9.JNS101223 |
Alternate Journal | J Neurosurg |
PubMed ID | 20964595 |
PubMed Central ID | PMC3622705 |
Grant List | K08 CA130985 / CA / NCI NIH HHS / United States UL1 RR024996 / RR / NCRR NIH HHS / United States CA130985 / CA / NCI NIH HHS / United States UL1-RR024996 / RR / NCRR NIH HHS / United States |
Related Institute:
MRI Research Institute (MRIRI)