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Convection-enhanced drug delivery for glioblastoma: a review

Journal of Neuro-Oncology volume 151, pages 415–427 (2021)Cite this article

Abstract

Introduction

Convection-enhanced delivery (CED) is a method of targeted, local drug delivery to the central nervous system (CNS) that bypasses the blood-brain barrier (BBB) and permits the delivery of high-dose therapeutics to large volumes of interest while limiting associated systemic toxicities. Since its inception, CED has undergone considerable preclinical and clinical study as a safe method for treating glioblastoma (GBM). However, the heterogeneity of both, the surgical procedure and the mechanisms of action of the agents studied—combined with the additional costs of performing a trial evaluating CED—has limited the field’s ability to adequately assess the durability of any potential anti-tumor responses. As a result, the long-term efficacy of the agents studied to date remains difficult to assess.

Materials and methods

We searched PubMed using the phrase “convection-enhanced delivery and glioblastoma”. The references of significant systematic reviews were also reviewed for additional sources. Articles focusing on physiological and physical mechanisms of CED were included as well as technological CED advances.

Results

We review the history and principles of CED, procedural advancements and characteristics, and outcomes from key clinical trials, as well as discuss the potential future of this promising technique for the treatment of GBM.

Conclusion

While the long-term efficacy of the agents studied to date remains difficult to assess, CED remains a promising technique for the treatment of GBM.

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Author notes

  1. Manish K. Aghi, Michael A. Vogelbaum, and Jeffrey N. Bruce have contributed equally to this work.

Affiliations

  1. Department of Neurological Surgery, Lenox Hill Hospital/Northwell Health, New York, NY, USA

    Randy S. D’Amico

  2. Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA

    Manish K. Aghi

  3. Department of NeuroOncology, Moffitt Cancer Center, Tampa, Fl, USA

    Michael A. Vogelbaum

  4. Department of Neurological Surgery, New York Presbyterian/Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA

    Jeffrey N. Bruce

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D’Amico, R.S., Aghi, M.K., Vogelbaum, M.A. et al. Convection-enhanced drug delivery for glioblastoma: a review. J Neurooncol 151, 415–427 (2021). https://doi.org/10.1007/s11060-020-03408-9

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Keywords

  • Glioblastoma
  • Glioma
  • Topotecan
  • Convection-enhanced delivery
  • Convection
  • High-grade glioma
  • Brain tumor
  • Blood–brain barrier
  • Drug delivery