Department of Neurological Surgery, Blood-Brain Barrier Program, Oregon Health and Science University, 3181 Sam Jackson Parkway Road, L603, Portland, OR 97239, USA.
Neurology. 2011 Jan 4;76(1):87-93. doi: 10.1212/WNL.0b013e318204a3af.
One rationale behind the use of agents that inhibit vascular endothelial growth factor in the therapy of primary CNS malignancies is based upon the concept that normalization of tumor vasculature with a decrease in tumor interstitial pressure will improve access of cytoreductive drugs and improve radiotherapy efficacy due to increased oxygen delivery. However, several studies have raised the concern that these agents may both rapidly restore the low permeability characteristics of the blood-brain barrier and counteract the beneficial effect of pseudoprogression. The result may be decreased therapeutic efficacy while increasing infiltration by co-opting normal vessels. In this discussion, we examine both histologic and radiographic tumor progression in the context of antiangiogenic agents. Issues dealing with the safety of bevacizumab (Avastin®, Genentech, South San Francisco, CA) and its potential to decrease efficacy of standard radiochemotherapy when used to treat patients with newly diagnosed malignant glioma are emphasized.
在原发性中枢神经系统恶性肿瘤的治疗中使用血管内皮生长因子抑制剂的一个基本原理是基于这样的概念，即通过降低肿瘤间质压力使肿瘤血管正常化，将改善细胞减灭药物的进入，并由于增加氧气输送而提高放疗效果。然而，几项研究引起了人们的关注，即这些药物可能会迅速恢复血脑屏障的低通透性特征，并抵消假性进展的有益作用。其结果可能是治疗效果降低，而通过利用正常血管的浸润增加。在本次讨论中，我们将在抗血管生成药物的背景下研究组织学和影像学肿瘤进展。强调贝伐单抗（Avastin®，基因泰克，旧金山，加利福尼亚州）的安全性问题及其在用于治疗新诊断的恶性神经胶质瘤患者时降低标准放化疗疗效的潜在风险。
