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Session Title: Taking the Fight into the Tumor: Intratumoral Therapies and Novel Approaches to Blood Brain Barrier Disruption

Description: Despite recent therapeutic advances, brain tumors remain an often fatal, and complicated-to-treat disease. Patients with the most common malignant brain tumor, Glioblastoma (GBM), rarely live more than two years despite aggressive treatment with maximal safe surgical resection followed by radiation and chemotherapy to the remaining invading tumor cells. However, delivering effective and durable treatments is a major challenge due to the blood-brain barrier, tumor microenvironment and molecular heterogeneity of the invasive GBM cells. As such, new treatment strategies are urgently needed to circumvent these obstacles and improve treatment success. Several innovative approaches are improving drug delivery across the blood brain barrier, enabling enhanced drug distribution in the regions of infiltrating cells and providing multi-modal activity against specific subclasses of tumor cells. Oncolytic viruses, developed as a therapy to directly infect and kill cancer cells are now being used to stimulate an immune response against tumors. Intra-arterial delivery of chemotherapy through novel microcatheters and other endovascular devices utilizing selective intra-arterial cerebral infusion techniques is used to accurately and super selectively target GBM supplying vessels and allow for focused delivery of chemotherapeutic agents with less systemic toxicity. Increasing our knowledge of the patho-biology of the barriers limiting effective treatment delivery to glioma cells will help advance the field of neuro-oncology, potentially improve outcomes for patients with devastating and fatal brain tumors and identify promising new therapeutic delivery approaches and create meaningful efficacy against deadly gliomas. This session will feature experts discussing these treatment strategies for patients with GBM and other CNS malignancies. In this session, we will (1) review the critical barriers to improving therapeutic delivery to invasive tumors, specifically, the blood-brain barrier; (2) explore the role of novel oncolytic virotherapy for treatment of GBM; and (3) discuss the role of intra-arterial delivery of chemotherapy for treatment of CNS malignancies. Advances in therapeutic delivery approaches and an increased understanding of brain tumor patho-biology have the potential to improve therapies for intracranial tumors.

Chair: Jan Drappatz, MD, University of Pittsburgh

Co-Chair: Megan Mantica, MD, University of Pittsburgh

Objective(s):

• To describe strategies to improve therapeutic delivery into the CNS
• To describe the rationale for intra-arterial approaches in the treatment of brain tumors
• To evaluate results of ongoing clinical trials examining viral agents as part of treatment paradigms

Presentations:

Drug Delivery Across the Blood Brain Barrier

Speaker:

Stuart Grossman, MD

Johns Hopkins University, School of Medicine

Oncolytic Virotherapy

Speaker:

Annick Desjardins, MD, FRCPC

Duke University

Intra-Arterial Delivery of Chemotherapy

Speaker:

John Boockvar, MD

Zucker School of Medicine at Hofstra / Northwell