Trial Delivers Chemotherapy to Brain Starting with Leg Incision
The Capital Institute for Neurosciences has performed the first procedure in a clinical trial that delivers chemotherapy to brain tumors through a catheter inserted in the leg. Capital Health is the only hospital in the country conducting the trial.
During the procedure, Dr. Erol Veznedaroglu, an endovascular neurosurgeon, threaded a tiny catheter through the patient’s femoral artery in the leg, up through the body and neck and into the brain. Once the catheter reached the brain, chemotherapy was released to the blood vessels that feed the tumor. The drugs were carried by the natural blood flow of the vessels to infuse the tumor with the cancer-fighting agent.
Intra-arterial chemotherapy, or IAC, spares healthy tissue while delivering more chemotherapy straight to the malignancy.
Dr. Veznedaroglu, director of the Capital Institute for Neurosciences and chairman of the Department of Neurosurgery at Capital Health, said IAC targets the tumor without the systemic side effects that can come with intravenous chemotherapy delivered throughout the body.
The surgery was performed at the Institute’s National Brain Tumor Center.
“Three hours after the procedure, we were able to see on the MRI that the entire tumor was infused with the chemotherapy,” Dr. Veznedaroglu said. “That’s the first part: we can get the entire tumor. The next question is: Will this drug be the drug that kills the tumor? We don’t have the answer to that yet. We will be following all the patients in the trial to learn that answer. But we know this mechanism is golden.
“The key here is to have these various disciplines and specialties working together to provide a multi-disciplinary approach to attacking the tumor: oncologic neurosurgery, vascular neurosurgery, neuro-oncology and the other numerous clinical team members that treat patients at our center,” said Dr. Veznedaroglu.
The first patient, Luis Rodriguez, a 41-year-old father from Vineland, said in the days since the procedure he has felt strong. He said he is hopeful the procedure will successfully treat his brain cancer, but he knows the procedure is not proven and doctors are not calling it a cure.
“I don’t know if I will live a year, 10 years, or more. But I am happy to know that I am contributing to the science and that this may help other people,” he said.
His wife, Echnamy Coss, said she is thankful her husband is part of the trial.
"We were close to the end with Luis. He has an aggressively growing tumor and a third surgery was not an option. This trial has given us new-found hope and extra time with him. We are extremely grateful to be a part of this medical breakthrough with Capital Health and its team of doctors,” she said.
IAC has been conducted at other centers, but oncologists and neurosurgeons at the Capital Institute for Neurosciences said the trial is the first to use a new protocol calling for delivery of high doses of the chemotherapy agent, Avastin, repeating the procedure every 20 days. They also will use MRIs to ensure the entire tumor is infused with the chemotherapy.
The procedure draws on techniques, skills and equipment created to treat complex brain disorders, such as stroke and aneurysm. It requires highly skilled endovascular neurosurgeons who can properly deliver the cancer-fighting agents to the right blood vessels to fully infuse the tumor with chemotherapy.
The Capital Institute for Neurosciences provides state-of-the-art care for complex conditions involving the brain and spine, and it performs more brain and aneurysm surgery than any other hospital in New Jersey.
“This is the ideal place for this clinical trial,” said Dr. Arlan Mintz, director of Neurosurgical Oncology at the Capital Institute for Neurosciences. “We think the high doses of chemotherapy have the best chance of working, and this is a way to deliver the high dose directly to the tumor while reducing the systemic effects on the rest of the body. This is generally well tolerated by patients.”
The trial focuses on recurrent glioblastoma multiforme, a type of brain tumor that originates in the brain. Dr. Mintz said the procedure could also at some point be used to treat metastatic cancers.
“We know that we need to continue to find new ways to treat these patients, particularly those who have a tumor that reoccurs after surgical resection,” said Dr. Roy Patchell, director of Neuro-Oncology at the Institute. “This approach harnesses all of the resources at our disposal and hopefully provides a one-two punch for patients.”
Anyone interested in learning more about the procedure can call 609-537-7300.