Superselective intraarterial cerebral infusion of cetuximab with blood-brain barrier disruption combined with Stupp Protocol for newly diagnosed glioblastoma
Kay O. Kulason, Julia R. Schneider, Shamik Chakraborty, Christopher G. Filippi, Bidyut Pramanik, Tamika Wong, Sherese Fralin, Karissa Tan, Ashley Ray, Rachel A. Alter, Rafael Ortiz, Alexis Demopoulos, David J. Langer and John A. Boockvar
We describe the first case of a novel treatment for a newly diagnosed glioblastoma (GBM) using super selective intraarterial cerebral infusion (SIACI) of cetuximab after osmotic disruption of the blood-brain barrier (BBB) with mannitol. A 51year-old female underwent craniotomy for removal of a right frontal GBM. Pathology confirmed EGFR amplification, and she underwent three treatments of SIACI of cetuximab to the tumor site. The first treatment was given within a week of starting standard of care chemoradiation (Stupp protocol), which is a combination of radiation treatment (2 Gy per/ day x 30 days, total of 60 Gy) and oral temozolomide (75 mg/m2). The second and third SIACI of cetuximab were administered 3 and 6 months later, while the patient continued on maintenance temozolomide. Post-radiation changes on MRI were stable, and there were no signs of recurrence at 4 and 6 months post-resection. Herein, we detail the technical aspects of this novel treatment paradigm and suggest that SIACI of cetuximab after BBB disruption using mannitol, combined with the standard of care chemoradiation therapy, may be an effective treatment method for newly diagnosed EGFR amplified glioblastoma.
Keywords: Intra arterial, Cetuximab, blood brain barrier disruption, mannitol, glioblastoma multiforme, GBM, EGFR amplified, SIACI