[2010年的胶质母细胞瘤治疗]
[Glioblastoma treatment in 2010].
作者信息
Djedid R, Tomasi O, Haidara A, Rynkowski M, Lefranc F
机构信息
Service de Neurochirurgie, Hôpital Erasme, Bruxelles.
出版信息
Rev Med Brux. 2009 Sep-Oct;30(5):496-505.
The treatment of glioblastomas requires a multidisciplinary approach because despite the progresses in surgical and iconographic managements associated with research knowledge this disease presently remains incurable and progresses during the 6 months after its diagnose. Current recommendations are that patients with glioblastoma should undergo maximum surgical resection followed by concurrent radiation and chemotherapy with the alkylating drug temozolomide, followed subsequently by additional adjuvant temozolomide for a period of up to 6 months. Temozolomide mechanism of action is complex and we have recently evidenced a temozolomide-associated anti-angiogenic activity in vitro and in vivo on preclinical human glioblastoma models. We describe in the current review the temozolomide-associated antiangiogenic activity. We also describe here the major signaling pathways that can be constitutively activated in migrating glioma cells, and which render these cells resistant to proapoptotic insults such as conventional chemotherapies. In light of this resistance, we therefore describe the targeted therapies and local drug delivery systems which could be used to complement conventional treatments. We have reviewed more than 400 ongoing clinical trials with respect to these new targeted therapy approaches alone or in combination for glioblastoma therapy and we also emphasize the importance of vaccinotherapy. We conclude our review with a therapeutic model that could be used in the light of the present knowledge.
胶质母细胞瘤的治疗需要多学科方法,因为尽管在与研究知识相关的手术和影像学管理方面取得了进展,但这种疾病目前仍然无法治愈,并且在诊断后的6个月内会进展。目前的建议是,胶质母细胞瘤患者应接受最大程度的手术切除,随后同时进行放疗和使用烷化剂替莫唑胺的化疗,随后再进行长达6个月的额外辅助替莫唑胺治疗。替莫唑胺的作用机制复杂,我们最近在临床前人类胶质母细胞瘤模型中证实了替莫唑胺在体外和体内具有与抗血管生成相关的活性。我们在当前的综述中描述了替莫唑胺相关的抗血管生成活性。我们还在此描述了在迁移的胶质瘤细胞中可被组成性激活的主要信号通路,这些信号通路使这些细胞对诸如传统化疗等促凋亡损伤具有抗性。鉴于这种抗性,我们因此描述了可用于补充传统治疗的靶向治疗和局部药物递送系统。我们仅就这些用于胶质母细胞瘤治疗的新靶向治疗方法单独或联合进行了400多项正在进行的临床试验的综述,并且我们还强调了疫苗治疗的重要性。我们根据目前的知识得出了一个可用于治疗的模型,以此结束我们的综述。