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Advances in Molecular Imaging of Locally Delivered Targeted Therapeutics for Central Nervous System Tumors
Umberto Tosi1, Christopher S Marnell2, Raymond Chang3
1Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA. umt2001@med.cornell.edu.
Abstract:
Thanks to the recent advances in the development of chemotherapeutics, the morbidity and mortality of many cancers has decreased significantly. However, compared to oncology in general, the field of neuro-oncology has lagged behind. While new molecularly targeted chemotherapeutics have emerged, the impermeability of the blood-brain barrier (BBB) renders systemic delivery of these clinical agents suboptimal. To circumvent the BBB, novel routes of administration are being applied in the clinic, ranging from intra-arterial infusion and direct infusion into the target tissue (convection enhanced delivery (CED)) to the use of focused ultrasound to temporarily disrupt the BBB. However, the current system depends on a "wait-and-see" approach, whereby drug delivery is deemed successful only when a specific clinical outcome is observed. The shortcomings of this approach are evident, as a failed delivery that needs immediate refinement cannot be observed and corrected. In response to this problem, new theranostic agents, compounds with both imaging and therapeutic potential, are being developed, paving the way for improved and monitored delivery to central nervous system (CNS) malignancies. In this review, we focus on the advances and the challenges to improve early cancer detection, selection of targeted therapy, and evaluation of therapeutic efficacy, brought forth by the development of these new agents.
Insights
New theranostic agents offer improved monitoring for brain cancer drug delivery, overcoming blood-brain barrier challenges. This approach aids early detection and therapy evaluation for central nervous system malignancies.
Area of Science:
- Neuro-oncology
- Pharmacology
- Medical Imaging
Background:
- Chemotherapeutic advances have improved cancer outcomes, but neuro-oncology lags due to the blood-brain barrier (BBB) limiting drug delivery.
- Current methods like intra-arterial infusion, convection-enhanced delivery (CED), and focused ultrasound have limitations.
- The "wait-and-see" approach for drug delivery lacks real-time feedback, hindering timely adjustments.
Purpose of the Study:
- To review advances in theranostic agents for central nervous system (CNS) malignancies.
- To highlight challenges and opportunities in improving early cancer detection, targeted therapy selection, and efficacy evaluation.
- To explore how theranostics can enable monitored drug delivery across the BBB.
Main Methods:
- Review of current literature on neuro-oncology drug delivery strategies.
- Analysis of novel theranostic agents combining imaging and therapeutic capabilities.
- Discussion of methods to overcome the blood-brain barrier (BBB).
Main Results:
- Theranostic agents show promise for simultaneous imaging and therapy in CNS cancers.
- These agents facilitate real-time monitoring of drug delivery and therapeutic response.
- Overcoming the BBB remains a key challenge, with theranostics offering a potential solution.
Conclusions:
- Theranostic agents represent a significant advancement for treating CNS malignancies.
- They enable precise monitoring of drug delivery, improving treatment efficacy and patient outcomes.
- Further development is crucial to fully realize the potential of theranostics in neuro-oncology.
