Table 2.
Strategy | Effectiveness for CNS Malignancy | Toxicity/Adverse Effects Profile | Introduction into Clinical Practice | Repeated/Continuous Administration | Tumor Size and CNS Location |
---|---|---|---|---|---|
Osmotic BBB disruption (IA mannitol) | Not established (only phase II studies) | Invasive procedure. May be associated with SAE. Frequency varies | Limited. Requires multidisciplinary expert team approach | Feasible but limited by invasiveness of the procedure | Safety limited by tumor size, mass effect, and location |
Biochemical disruption of the BBB (IA RMP-7) | Not established (only phase II studies) | Invasive procedure. Associated with SAE. | Clinical practice discontinued | Feasible but limited by invasiveness and toxicity of the procedure | Safety may be limited by tumor size, mass effect, and location |
Focused ultrasound-mediated BBB disruption | No human studies (only small animals studies) | No human studies | No human studies | No human studies | Limited to small tumor size |
Abbreviations: IA, intra-arterial; SAE, severe adverse events.
aFor references, please see text.