Review Article

Convection-Enhanced Delivery in Malignant Gliomas: A Review of Toxicity and Efficacy

Table 1

Summary of clinical studies of CED in the treatment of malignant gliomas.

ReferenceTherapeutic agentTrial phaseDiagnosis (n)Infusion volumeInfusion rateTreatment responders
(n/total pts)
MeSTDrug-related adverse events (rate)

Laske et al., 1997 [64]Tf-CRM107 (TransMID)I/IIGBM (9)
AA (5)
AO (1)
5-180 mL0.24-0.6 mL/h9/1574 wks (responders)
36 wks (non-responders)
Seizures (27%), local toxicity (20%), transit elevation of ALT, AST (93%), mild hypoalbuminemia (80%)

Weaver et al., 2003 [70]Tf-CRM107 (TransMID)IIRecurrent AA/GBM (44)5-180 mL0.2 mL/h/catheter
2 catheters
12/3437 wksSymptomatic progressive cerebral edema (24%), seizure (9%)

Rand et al., 2000 [65]IL-4 PE38KDEL (NBI-3001)IGBM (9)30-185 mL0.3-0.6 mL/h--Headache (11%), seizures (22%), anomia (11%), dysphasia (11%), communicating hydrocephalus (22%), weakness (22%), nausea (11%)

Weber et al., 2001 [66]
Weber et al., 2003 [90]
IL-4 PE38KDEL (NBI-3001)IGBM (25)
AA (6)
40-100 mL--Headache (45%), seizures (84%), weakness (32%), aphasia (23%), speech disorder (10%), hypoesthesia (16%), coma (10%), wound infection (10%), pyrexia (10%), nausea (23%)

Kunwar et al., 2003 [68]
Kunwar et al., 2006 [61]
Kunwar et al., 2007 [80]
IL13- PE38QQRIMG (5)
GBM (46)
19.2-51.8 mL
72 mL
0.4-0.54 mL/h intratumoral
0.75 mL/h intraparenchymal
--Headache (41 %), convulsion (14 %), sensory disturbance (25 %), aphasia/speech disorder (18 %), asthenia (16 %), hemiparesis (14 %), facial paresis (12 %), memory impairment (8 %), pyrexia (8 %), nausea (8 %)

Vogelbaum et al., 2007 [81]IL13- PE38QQRIGBM (22)
anaplastic mixed OA (1)
72 mL0.75 mL/h--Headache (50%), fatigue (73%), nausea (41%), convulsion (14%), confusion (14%), aphasia (14%), dyspepsia (14%), pyrexia (14%)

Kunwar et al., 2010 [57]IL13- PE38QQRIIIRecurrent GBM (296)72 mL0.75 mL/hNot reported36.4 wks IL13- PE38QQR vs. 35.5 wks Gliadel waferHeadache (0.4%), aphasia (1.2%), hemiparesis (0.8 %),
Monoparesis (0.5%), hemiplegia (0.3%), gait disturbance (0.3%), coordination abnormal (0.3%), mental status changes (0.3%)

Sampson et al., 2003 [91]
Sampson et al., 2008 [92]
TP-38IGBM (17), AO (1), GSC (1), Metastasis (1)40 mL0.4 mL/h--Headache (47%), hemiparesis (20%), speech (20%), constitutional (20%), ocular/visual (13%), seizure (8%)

Voges et al., 2003 [62]LIPO-HSV-1-tk GCVI/IIGBM (8)3.5 mL0.025-0.6 mL/h2/828.1 ± 3.0 wksTransient worsening of motor aphasia (25%), fever (25%), leukocytosis (25%), ALT (37.5%), AST (25%), LDH (12.5%), CRP (25%)

Lidar et al., 2004 [67]PaclitaxelI/IIGBM (13), AA/AO (1), Mixed AO (1)6-6.6 mL0.3 mL/h11/1532.1 wksChemical meningitis (40%), neurological deterioration due to peritumoral edema and necrosis (20%)

Pöpperl et al., 2005 [69]
Tanner et al., 2007 [72]
PaclitaxelIIRecurrent GBM (8)36 mL0.3 mL/h0/842.9 wksTemporary worsening of (pre-existing) neurological symptoms (63%), poor wound healing (25%), neurological deterioration (25%)

Patel et al., 2005 [76]131I-chTNT-1/B mAb (Cotara)I/IIRecurrent GBM (37) primary GBM (8)
AA (6)
4.5-18 mL0.18-0.72 mL/h1/1237.9 wksheadache (14%), convulsions (6%), simple partial seizures (4%), aphasia (6%), weakness (6%), hemiparesis (14%), facial palsy (4%), short-term memory loss (2%), fatigue (6%), nausea (4%)

Sampson et al., 2006 [93]I131-Ch81C6Recurrent GBM (10)4.5-18 mL0.18 mL/h3/1030.3 wks

Pandit-Taskar et al., 2018 [77]I124-8H9IDiffuse intrinsic pontine glioma0.25-4 mL0.05-0.45 mL/h--Headache (50%), ataxia (29%), facial palsy (36%), diplopia (25%), muscle weakness (22%), dysarthria (15%), anaemia (32%), platelet count decreased (25%), white blood cells decreased (67%), ALT (32%), AST (25%), hypoalbuminaemia (61%), rash (11%), skin infection (8%), vomiting (18%)

Boiardi et al., 2005 [73]Mitoxantrone0Recurrent MG (12)--Procedure problem (25%), infection (8%)

Carpentier et al., 2006 [63]CpG-ODNIRecurrent GBM (24)1 mL/catheter0.2 mL/h/catheter--Worsening of previous neurological condition (21%), partial seizures (21%), somnolence (8%), fever (21%), fatigue (25%), nausea (4%), lymphopenia (46%), ALT (25%), AST (4%)

Carpentier et al., 2010 [74]CpG-ODNIIRecurrent GBM (31)1 mL/catheter
2 catheters
0.2 mL/h/catheter3/3128 wksWorsening of previous neurological condition (65%), partial seizures (42%), general seizures (16%), fever (grade 2) (3%), fatigue (grade 2) (6%), hemorrhage leading to death 8 days after treatment (3%), lymphopenia (grade 2) (71%), lymphopenia (grade 3) (48%), ALT (10%)

Hau et al., 2007 [86]TGF-β2 inhibitor
Trabedersen
I/IIAA (5)
GBM (19)
23-81 mL/cycle up to 10 cycles0.24-0.32 mL/h24146.6 wks AA
44.0 wks GBM
Serious adverse events central and peripheral nervous system disorders (92%)

Bogdahn et al., 2011 [75]TGF-β2 inhibitor
Trabedersen
IIbRecurrent/ refractory GBM, AA (145)40 mL/cycle up to 11 cycles0.24 mL/hNot reportedAA: 39.1 mos (10 μM) vs. 35.2 mos (80 μM) vs. 21.7 mos (TMZ or PCV)
GBM: 7.3 mos (10 μM) vs. 10.9 mos (80 μM) vs. 10 mos (TMZ or PCV)
Headache (10%), nervous system disorders (59-66%), depressed level of consciousness (4-12%), hemiparesis (22-27%), aphasia (10-15%), neurological symptom (8-17%), convulsion (8-12%), injury poisoning, and procedural complications (16-17%), infections and infestations brain abscess (7-12%), psychiatric disorders (6-12%), blood and lymphatic system disorders (5-8%)

Bruce et al., 2011 [78]TopotecanIbRecurrent GBM (10), AA (2), AE (2), AO (2)40 mL0.2 mL/h--Headache (31%), seizure (31%), worsened hemiparesis (31%), right-hand dyscoordination (13%), upper-extremity weakness (6%), poor wound healing (13%), intracerebral hemorrhage (6%), thrombocytopenia/leukopenia (13%), gastrointestinal symptoms (25%)

Desjardins et al., 2018 [87]Recombinant poliovirusIIRecurrent GBM (61)3.25 mL0.5 mL/h-12.5 mos (PVSRIPO) vs. 11.3 mos (Historical control)Headache (52%), hemiparesis (50%), seizure (45%), dysphasia (28%), cognitive disturbance (25%), hemianopia (19%), confusion (18%), paresthesia (13%), fatigue (12%), nausea (10%)

Abbreviations. AA: anaplastic astroglioma; AE: anaplastic ependymoma; ALT: alanine aminotransferase; AST: aspartate aminotransferase; AO: anaplastic oligodendroglioma; GSC: gliosarcoma; MG: malignant glioma; n: number of patients; OA: oligoastrocytoma; pts: patients.