Chemotherapy is the use of drugs to treat and fight cancer, it was used for the first time in the 1950s. Its usefulness has allowed many people to have full lives. The chemotherapy drugs your doctor or nurse administers have been tested numerous times, and research has shown that they are effective in helping fight cancer cells.

According to the American Cancer Society, there are currently more than 100 chemotherapy drugs. Doctors select certain medications according to the type of cancer and the stage of the disease.

Chemotherapy may be used to keep cancer from spreading, suppress its growth, kill cancer cells that might have spread to other parts of the body, relieve symptoms like pain or blockages caused by cancerous tumors, and cure cancer.

There are also different methods of chemotherapy administration:

Intra-arterial or IA

In IA chemotherapy, the drug is delivered via a microcatheter advanced directly into the arteries that supplies blood to the tumor to treat a single area (such as the liver, an arm, or leg). This method helps limit the effect the drug has on other parts of the body and is called regional chemotherapy.

Intrathecal or IT

IT chemotherapy is administered through a needle into the spinal canal and goes into the fluid that surrounds the brain and spinal cord to reach cancer cells there. This fluid is called the cerebrospinal fluid or CSF. This is important because most chemotherapeutic drugs delivered by IV or orally are unable to reach the brain due to the blood-brain barrier.

Intra-ventricular

Chemotherapy can also be delivered to the CSF through a surgically implanted long-term catheter and port that can be administered under the scalp. This port is called an Ommaya reservoir; a small drum-like device with a small tube attached to it. The tube goes into the CSF in a cavity of your brain and stays in place under your scalp while treatment is done.

Intravenous or IV

Chemotherapeutic drugs are delivered right into the bloodstream through a catheter inserted into a forearm's vein.

Oral

Chemotherapy pills, capsules or liquid are swallowed – just like other medicines.

Intracavitary

Chemotherapeutic drugs may be given through a catheter into an enclosed area of the body such as the abdomen (this is called intraperitoneal chemotherapy) or chest (called intrapleural chemotherapy).

Intramuscular or IM

The drug is administered through a needle into a muscle (as an injection or shot).

Intralesional

A needle is used to administered the drug right into a tumor. It’s only possible when the tumor can be safely reached with a needle.

Intravesical

The chemotherapy is administered right into the bladder through a soft catheter. It stays in for a few hours and is then drained out, and the catheter is removed.

Topical

The drug is administered right on an area of cancer on the skin as a cream, gel, or ointment.

Interventional Oncology

Treatment of cancer using minimally invasive procedures performed under image guidance date back to the birth of Interventional Radiology in the 1960s. The first arterial embolizations of kidney and liver tumors were performed back then; the aim was to alleviate symptoms associated with hormones, reduce bleeding, and relieve pain. This period also yielded the first studies of intra-arterial chemotherapy delivery as an option for the treatment of metastatic liver diseases.

Since the early 1990s, minimally invasive image-guided therapies used in interventional oncology to treat hepatocellular carcinoma have continued to evolve. In addition, the range of applications has been extended to the treatment of liver metastases from colorectal cancer, neuroendocrine tumors, cholangiocarcinoma, breast cancer, melanoma and sarcoma.

Intra-arterial treatment is continuously performed in different countries all over the world (see publications). Its advantages include being less painful and debilitating for the patient, allowing faster convalescence, and causing fewer overall side effects and complications.

What IDOI does differently is the preparation, mixing, dosage and sequential administration of the different medications that integrates the treatment’s model. It also uses the intrathecal route to administer medications.

The interventional oncology that IDOI performs consists in a puncture made in the femoral artery through which a micro catheter is inserted and directed by fluoroscopy to the blood supply site of the tumor.

The risks related with the procedure are minimal and imply the formation of a hematoma in the puncture site (less than 5%) and a possible vascular event such as a stroke (less than 0.7%). The other part of the procedure consists in making a lumbar puncture after the intra-arterial treatment with the application of medications.

The inherent risks of this procedure are pain in the puncture site, the formation of a hematoma and some irritation of the cauda equine (radiculitis) that occurs in less than 1% of the cases.

All medication used by IDOI are approved by Cofepris and FDA.

Intra-arterial chemotherapy for DIPG

Cancer patients with grim prognoses may resort to intra-arterial chemotherapy as compassionate use treatment, since it may reduce cancer symptoms, increase survival rates, and minimize drug side effects.

The treatment provided by IDOI for DIPG is an option even after patients have received traditional treatment in their country of origin.

A European Society of Pediatric Oncology (SIOPE) and the International Society of Pediatric Oncology (SIOP) collaborative report, which gathers records of Diffuse Intrinsic Pontine Glioma (DIPG) and was published in July 2018, reveals that the average survival rate in more than 700 cases is 11 months.

As of early-2019, IDOI has treated over 70 patients with an average age of 9 years diagnosed with DIPG. After treatment, the median survival is 24 months (Kaplan-Meier). Just over 90 percent of the patients had over 1 year of survival and 50 percent more than 2 years of survival. The Institute continues to advance and improve.

IDOI stands out as an institution by virtue of its statistics, since it has 10 percent of the SIOPE and SIOP patient registry, and for obtaining more favorable patient outcomes on average.

According to the American Cancer Society, chemotherapy is used as a treatment with various aims:

Cure

If possible, chemotherapy is used to cure cancer, meaning that the cancer is destroyed – it goes away and doesn’t come back.

Most doctors don’t use the word “cure” except as a possibility or intention. So, when giving treatment that has a chance of curing a person’s cancer, the doctor may describe it as treatment with curative intent.

There are no guarantees, and though cure may be the goal, it doesn’t always work out that way. It often takes many years to know if a person’s cancer is really cured.

Control

If cure is not possible, the goal may be to control the disease. Chemotherapy is used to shrink tumors and/or stop the cancer from growing and spreading. This can help the person with cancer feel better and live longer.

In many cases, the cancer doesn’t completely go away, but is controlled and managed as a chronic disease, much like heart disease or diabetes. In other cases, the cancer may even seem to have gone away for a while, but it’s expected to come back. Then chemotherapy can be given again.

Palliation

Chemotherapy can also be used to ease symptoms caused by the cancer. This is called palliative chemotherapy or palliation.

When the cancer is at an advanced stage, meaning it’s not under control and has spread from where it started to other parts of the body, the goal may be to improve the quality of life or help the person feel better. For instance, chemotherapy may be used to help shrink a tumor that’s causing pain or pressure.

And lest we forget, in some cases, a treatment can be described as Compassionate.

Compassionate use

The compassionate use programs around the world offer patients access to treatments and drugs otherwise outside their reach when the following characteristics are present:

Patient has a serious disease or condition, or whose life is immediately threatened by their disease or condition.
There is no comparable or satisfactory alternative therapy to diagnose, monitor, or treat the disease or condition.
Potential patient benefit justifies the potential risks of treatment.

*Taken from the Expanded access FDA page.

Request for admission to the program

Thank you for your interest in the program offered by IDOI. As a first encounter, we ask you to fill an application request form through which we will evaluate your case as thoroughly as possible to decide whether the treatment can be effective for the case or not. All candidates are carefully evaluated; this is why we ask you to complete the form to start your request process.

*It is necessary to have a Google Account.

Apply here for IDOI Intra-arterial Treatment

After receiving your form and all the additional files that you wish to share with us, we will process the information and contact you as soon as a decision is made. The process generally takes a week, but it could take more time depending on the complexity of the case.

After admission

If you are admitted to our program, you will receive an appointment date and must start making travel arrangements. Please consult our Frequently Ask Questions section to obtain information about transport and accommodation options.

Myths and realities

MYTH: The treatment offered by IDOI cures cancer, particularly in DIPG cases.

REALITY: The IDOI program for DIPG is compassionate in nature, so IDOI cannot guarantee a cure. Each patient responds differently to the treatment provided, but in most cases shrinking of tumor size has been observed, which generally translates into an improvement of neurological deterioration signs and symptoms.
As a result, most of its patients see improvement in quality of life and their survival rate improves.
MYTH: Every DIPG case treated by IDOI sees favorable results immediately.

REALITY: Once the patient is accepted into the IDOI program, treatment begins almost immediately, which enables tangible results to be seen in most but not all cases within the first days or weeks after undergoing the initial procedure.
MYTH: The treatment offered by IDOI for DIPG cases produces no side effects whatsoever.

REALITY: Interventional oncology, like any other invasive procedure, can have some side effects, albeit minimal since it consists of a course of treatment considered nontoxic. Main side effects, however, are pain in puncture sites (groin and lumbar region), moderate and temporary fever (several hours), headache, mild vomiting, and lack of appetite.
MYTH: The Institute of Interventional Oncology does not have clinical research protocols.

REALITY: IDOI is a clinical institution that seeks to offer standard and compassionate treatments that can improve its patients’ survival and quality of life and continuously conducts research to perfect its procedures.

Additionally, course of treatment is completely customized and constantly assessed and tailored in order to yield the greatest benefits possible. As such, it cannot be categorized as a generic or standardized treatment.
MYTH: IDOI has not disclosed data supporting its treatment outcomes.

REALITY: The abstract “Super-Selective Intra-arterial and Intra-techal Chemotherapy in the Compassionate management of Diffuse Intrinsic Pontine Glioma: 2-year experience from an institution in Mexico” was accepted in May 2018 in the framework of the XII Congress of Latin American Immunology (ALAI) and the XXIII Congress of the Mexican Immunology Society (SMI), substantiating the advances of 2 years of work in over 60 cases.

Currently, other research is in the process of being documented and will be published.
MYTH: Requests from international scientists to obtain more information about treatment for DIPG cases have been ignored by IDOI specialists.

REALITY: Factors, such as patients’ rights to privacy, the vast amount of international cases that the IDOI treats, and the few resources with which it operates -100 per cent focused on treatment- come into play, which complicate ideal data sharing by the Institute’s medical team.

However, IDOI has strengthened its research staff, which will allow specialists to share information in the form of abstracts with the medical community.
MYTH: IDOI only accepts international patients.

REALITY: IDOI analyses isolated and complex brain cancer cases with grim prognoses from various countries, including Mexico. As a result, the number of patients both from Monterrey and Mexico as a whole are represented and is proportional to the rest of the world.
MYTH: The IDOI medical team has refused to provide their treatment in other countries.

REALITY: Today, IDOI cares for patients who reside in over 10 countries spread over 4 continents. The distance and requirements needed for treatment make it impossible for doctors to be able to travel and be at patients’ bedside in person, as it would mean leaving many other patients without care. Therefore, the most practical solution is to concentrate them in Monterrey, Mexico, because of its excellent flight connections, magnificent hospital infrastructure, and its proximity to the United States.
MYTH: The drugs used by IDOI for intra-arterial chemotherapy are of dubious quality and/or origin.

REALITY: IDOI only uses products of the highest quality to ensure the best service available. All drugs used are Cofepris (Mexican Federal Commission for the Protection Against Sanitary Risk) and FDA (U.S. Food and Drug Administration) approved. From the onset of the interventionist oncology program, the course of treatment has maintained a basic structure of chemotherapeutic drugs. However, IDOI constantly evaluates new medications, on the lookout for those that could deliver better results.
MYTH: IDOI doctors administer high doses of intra-arterial drugs in an effort to eradicate DIPG.

REALITY: IDOI’s signature method allows the delivery of a high concentration of drugs to a specific target site with low dosages of medication and as a result the amount of medicine is diluted in the body’s other organs, for minimal quantities compared to previous similar procedures only a few years ago. This way, substances are delivered to the cancerous tissue without exposing the whole body to the drugs’ effects.
MYTH: The only way to measure IDOI treatment effectiveness is by tracking the tumor with MRIs.

REALITY: Tumors’ response to IDOI treatment varies in each case. However, MRIs performed after each procedure have revealed a reduction in size in almost every instance; furthermore, the oncology community recognizes that the mere fact of halting a tumor’s growth represents a significant achievement. Another way of knowing if the treatment was effective is by seeing an improvement in the signs and symptoms of neurological deterioration in the patient.
MYTH: The Institute of Interventional Oncology constantly changes its medication provider.

REALITY: The strategic relationships entered in by IDOI -with its medication provider, for example- are fundamental. Because of this, it strives to maintain its current ties and to pursue new ones, in an ongoing quest for greater benefits for its patients.
MYTH: International patients at IDOI have trouble gaining access to or obtaining follow up from the Institute’s medical specialists. They are, however, forced to return on a monthly basis for treatments.

REALITY: A number of obstacles hinder frequent and ideal quality face-to-face communication between IDOI specialists and patients, such as international time zones, foreign languages, and doctors’ intense workload, not to mention the extraordinary attention demanded by each case.

However, IDOI’s team of specialists is always willing to work with patients’ doctors in their home country and takes care to maintain frequent e-mail contact with the patient’s family.

Regarding treatments’ frequency, its duration can vary depending on each patient’s response. Personalized treatment is administered every 3 weeks with a tolerance period of up to 5 weeks.
MYTH: IDOI specialists are against medical treatments involving radiation.

REALITY: Overall, IDOI’s medical team does not prescribe radiotherapy for its patients, but in those cases when this treatment is unavoidable it does so in a particular way, with the aim of its being the least aggressive as possible on the healthy brain tissue surrounding the tumor.
MYTH: Treatment offered by IDOI is exceedingly expensive.

REALITY: Treating a catastrophic illness like cancer is always costly, but once favorable results are achieved, the benefit is priceless. The treatment provided by IDOI involves medical facilities, drugs, and doctor’s fees, which are more affordable and flexible in Mexico compared to those available in other parts of the world. Additionally, IDOI has entered agreements with several hospitals and private clinics so that services provided are as affordable as possible.
MYTH: IDOI have treated DIPG patients for 20 years.

REALITY: Although the first activities and practices of what is now IDOI date from the early 90's, the Institute formally opened its doors in 2017. Two successful careers and two complementary experiences, one in Oncology and the other in Interventional Neuroradiology, joined to create IDOI in an effort to find new ways of using various techniques, procedures, and drugs to benefit patients with very specific conditions where the disease can be controlled, the quality of life improved, and the survival rate and/or odds of cancer remission increased.

Instituto De Oncología Intervencionista

Treatments