Convection-enhanced delivery of immunomodulatory therapy for high-grade glioma.
Colin P SperringMichael G ArgenzianoWilliam M SavageDamian E TeasleyPavan S UpadhyayulaNathan J WinansPeter D CanollJeffrey N BrucePublished in: Neuro-oncology advances (2023)
The prognosis for glioblastoma has remained poor despite multimodal standard of care treatment, including temozolomide, radiation, and surgical resection. Further, the addition of immunotherapies, while promising in a number of other solid tumors, has overwhelmingly failed in the treatment of gliomas, in part due to the immunosuppressive microenvironment and poor drug penetrance to the brain. Local delivery of immunomodulatory therapies circumvents some of these challenges and has led to long-term remission in select patients. Many of these approaches utilize convection-enhanced delivery (CED) for immunological drug delivery, allowing high doses to be delivered directly to the brain parenchyma, avoiding systemic toxicity. Here, we review the literature encompassing immunotherapies delivered via CED-from preclinical model systems to clinical trials-and explore how their unique combination elicits an antitumor response by the immune system, decreases toxicity, and improves survival among select high-grade glioma patients.
Keyphrases
- high grade
- drug delivery
- newly diagnosed
- clinical trial
- end stage renal disease
- ejection fraction
- systematic review
- healthcare
- white matter
- multiple sclerosis
- oxidative stress
- emergency department
- rheumatoid arthritis
- patient reported outcomes
- peritoneal dialysis
- prognostic factors
- resting state
- pain management
- cerebral ischemia
- patient reported
- brain injury
- open label