Hopkins New Trial for Progressive DIPG

Johns Hopkins has put up a new pilot study for children (age one month to 17 years) with progressive DIPGs using intra-arterial (IA) chemotherapy.   This procedure will involve placing catheters into the arteries and guiding them to the blood vessels that directly feed the tumor.    Melphalan hydrochoride, a chemotherapeutic agent, will be delivered directly into these vessels at two intervals 4 weeks apart.  The hope is to increase the amount of drug to the tumor while decreasing the toxicity to the rest of the body.

An interesting part of this study in the interdepartmental nature of the panel which approves inclusion to the study.   The panel included two neuro-oncologists- Ken Cohen and Eric Rabbe; a neurosurgeon- George Jallo; a radiation oncologist- Stephanie Tezakis; and a interventional neuroradiologist- Monica Pearl.   A truly novel part of this study is that the primary investigator is the interventional neuroradiologist!   It is exciting to see such a diverse team interested in novel ways to combat DIPG.

One of the hurdles for DIPG, and in fact all brain tumors, has been getting adequate drug to the tumor.   There have been some attempts at trying to get chemotherapy directly to the tumor through the arteries in the past.    In 2011, Cornell neurosurgeons published an article using the basilar artery to instill chemotherapy near recurrent pediatric ependymomas.   Prior to that there was a publication on blood-brain barrier disruption chemotherapy specifically for diffuse pontine gliomas.  Given the failures so far with DIPG treatment, it is good to see another institution interested in new ways to treat DIPG.

This pilot study is being funded by Solving Kids' Cancer.   This organization, founded by two fathers of children with neuroblastoma, has a mission "to create more effective and less toxic treatment options for kids with the deadliest childhood cancers.  Solving Kids' Cancer's therapeutic paths include genomics, tumor initiating cells, biotherapeutics, immunotherapeutics, embryonic development mechanisms, tumor cell surface receptor and implicated molecular pathways.

References:
Intra-arterial Chemotherapy for the Treatment of Progressive Diffuse Intrinsic Pontine Gliomas
http://www.hopkinsmedicine.org/interventional_neuroradiology/conditions_procedures/progressive_diffuse_intrinsic_pontine_glioma

Super-selective basilar artery infusion of bevacizumab and cetuximab for multiply recurrent pediatric ependymoma
http://www.ncbi.nlm.nih.gov/pubmed/22192550

Osmotic blood-brain barrier disruption chemotherapy for diffuse pontine gliomas
http://www.ncbi.nlm.nih.gov/pubmed/16314949