Imaging the Timing of Cytotoxic and Anti-Angiogenic Therapy

Gregory L. Pishko¹, Morad Nasseri¹, Seymur Gahramanov¹, Leslie L. Muldoon¹, Edward A. Neuwelt¹, ²

Timing and sequencing of chemotherapy and anti-angiogenic therapy may play an important role in anti-brain tumor efficacy. A pilot study was conducted to use MRI to elucidate vascular and interstitial fluid differences that correspond with the timing of temozolomide (chemotherapy) and bevacizumab (anti-angiogenic) delivery. Rats with intracerebrally implanted human gliomas were randomized to three treatment groups: control, bevacizumab followed by temozolomide 4 days later, and temozolomide followed by bevacizumab 4 days later. Permeability measurements and T2W imaging demonstrated that it may be more effective to deliver chemotherapy before anti-angiogenic therapy and warrants further study.