Idbaih Ahmed, Ducray François, Sierra Del Rio Monica, Hoang-Xuan Khê, Delattre Jean-Yves
INSERM, Unité 711, Paris, France.
Oncologist. 2008 Sep;13(9):978-92. doi: 10.1634/theoncologist.2008-0056. Epub 2008 Sep 8.
Growth factor receptors and angiogenesis play major roles in the oncogenesis of gliomas. Over the last several years, several noncytotoxic molecular targeted therapies have been developed against growth factor receptors and tumor angiogenesis. In gliomas, two main anti-growth factor receptor strategies have been evaluated in phase I/II clinical trials: (a) small molecule tyrosine kinase inhibitors (TKIs) and (b) monoclonal antibodies that target growth factors or growth factor receptors other than vascular endothelial growth factor (VEGF). Up to now, few glioma patients have responded to small TKIs (0%-14%) or monoclonal antibodies (three case reports) delivered as a single agent. Greater doses, combined therapies, as well as the identification of molecular biomarkers predictive of response and resistance are important in order to optimize drug delivery and improve efficacy. Antiangiogenic therapies are promising for the treatment of gliomas. Thalidomide and metronomic chemotherapy were the first antiangiogenic strategies evaluated, but they have shown only modest activity. Recent studies of bevacizumab, an anti-VEGF antibody, and irinotecan, a topoisomerase I inhibitor, have demonstrated a high response rate, suggesting that targeted antiangiogenic therapies may play a significant role in the management of high-grade gliomas in the future. However, the toxicity profiles of these agents are not fully defined and the radiological evaluation of possible tumor response is challenging. Clinical evaluation of several VEGF receptor TKIs is currently ongoing; one of these inhibitors, cediranib, has already demonstrated interesting activity as a single agent. The integrin inhibitor cilengitide represents another promising strategy.
生长因子受体和血管生成在胶质瘤的肿瘤发生中起主要作用。在过去几年中,已经开发了几种针对生长因子受体和肿瘤血管生成的非细胞毒性分子靶向疗法。在胶质瘤中,已经在I/II期临床试验中评估了两种主要的抗生长因子受体策略:(a)小分子酪氨酸激酶抑制剂(TKIs)和(b)靶向除血管内皮生长因子(VEGF)以外的生长因子或生长因子受体的单克隆抗体。到目前为止,很少有胶质瘤患者对作为单一药物使用的小分子TKIs(0%-14%)或单克隆抗体(三个病例报告)有反应。为了优化药物递送并提高疗效,更大的剂量、联合疗法以及识别预测反应和耐药性的分子生物标志物很重要。抗血管生成疗法对胶质瘤的治疗很有前景。沙利度胺和节拍化疗是最早评估的抗血管生成策略,但它们仅显示出适度的活性。抗VEGF抗体贝伐单抗和拓扑异构酶I抑制剂伊立替康的最新研究已显示出高反应率,这表明靶向抗血管生成疗法未来可能在高级别胶质瘤的治疗中发挥重要作用。然而,这些药物的毒性特征尚未完全明确,对可能的肿瘤反应进行放射学评估具有挑战性。目前正在对几种VEGF受体TKIs进行临床评估;其中一种抑制剂西地尼布作为单一药物已经显示出有趣的活性。整合素抑制剂西仑吉肽代表了另一种有前景的策略。
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