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Intra-arterial, intravitreal chemotherapy advances in retinoblastoma treatment
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KOLOA, Hawaii – Chemotherapy delivered intravitreally and intra-arterially are among advances in the field of retinoblastoma treatments, according to a speaker here.
“You may not take care of retinoblastoma yourself, but it’s important to be aware of the recent advances in the field,” J. William Harbour, MD, from Bascom Palmer Eye Institute, said at Retina 2014.
The standard of care for treating retinoblastoma remains systemic intravenous chemotherapy using carboplatin, vincristine and etoposide, followed by local treatment with laser, Harbour said.
William Harbour
In more severe cases, efficacy of standard chemotherapy goes down, leaving a gap for a new modality – intra-arterial chemotherapy, most commonly with melphalan, Harbour said.
“The pros are that we definitely save more eyes than we were able to with just systemic chemotherapy and by reducing exposure to systemic chemotherapy,” Harbour said. The cons, however, are that there may be significant radiation exposure from repeated fluoroscopy; the procedure is technically challenging and expensive; there are risks of ocular and orbital ischemia, arterial dissection and stroke; and the long-term side effects are not yet known.
Intravitreal chemotherapy is also a relatively new treatment modality that can be safely performed if done carefully with proper technique and a small needle, Harbour said. Again, long-term side effects are not known. –by Patricia Nale
Disclosure: Harbour receives consultant fees from Castle Biosciences, Genentech and Pfizer.