Most patients have traditionally received chemotherapy either orally or intravenously. When these methods are used, the blood-brain barrier poses a significant obstacle to treatment. The blood-brain barrier protects the brain by preventing toxins and other molecules in the bloodstream from entering brain cells.
Clinical trials are also aimed at finding new methods for administering medications to DIPG/DMG patients. Newer delivery methods, like convection-enhanced delivery (CED), Ommaya catheter delivery, and focused ultrasound, are being developed to disrupt the blood-brain barrier to allow more chemotherapy agents to pass.
Studies are currently being conducted to investigate these new methods that deliver medication directly into the tumor:
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An Ommaya reservoir is a small, plastic, dome-shaped device that is inserted under your scalp. The device is connected to a catheter that can dispense medication to your brain, bypassing the blood-brain barrier. Additionally, cerebral spinal fluid samples can be obtained through this device.
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Convection-enhanced delivery (CED)
CED was first developed in the early 1990s. It generates a pressure gradient at the tip of an infusion catheter to deliver therapeutics directly through the interstitial spaces of the central nervous system. This allows for distribution of medications past the blood-brain barrier. A catheter is stereotactically placed into the brain using image guidance.
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Focused ultrasound is noninvasive and is in early-stage development. It can be used by itself or in combination with other therapies. Focused ultrasound accurately targets diseased brain tissue without harming normal tissue. Additionally, there is no radiation delivered or surgical incisions for the patient. Focused ultrasound can improve the ability of chemotherapy to reach the tumor. It can be repeated if necessary.
