Neurosurgical Research Institute, University of Ioannina, Ioannina 45110, Greece.
Cancer Chemother Pharmacol. 2011 May;67(5):971-83. doi: 10.1007/s00280-011-1617-9. Epub 2011 Mar 27.
The standard therapy for newly diagnosed malignant gliomas comprises surgery, radiotherapy, and commonly temozolomide chemotherapy. For recurrent or progressive disease after temozolomide failure, there is no consensus and only limited options for chemotherapy.
We reviewed the English literature for phase II trials of therapies for recurrent malignant glioma conducted between January 2000 and September 2010. The search was supplemented by a review of articles published prior to 2000 on chemotherapy regimens that had shown activity on recurrent gliomas.
To guide practice in the general oncology setting, an algorithm was constructed according to the activity of the reported chemotherapies at the time of writing. Some molecular studies performed on tumor tissue may help guide the selection of chemotherapy. Methylated MGMT in tumor tissue correlates with increased sensitivity to alkylating agents such as fotemustine or other nitrosoureas. Depending on MGMT status and bone marrow reserve, treatment with fotemustine, bevacizumab, bevacizumab with irinotecan, or cis-retinoic acid (cRA), might be of value.
Unfortunately, progress in the development of new and more effective chemotherapy agents has been very limited and leaves the clinician treating high-grade glioma patients at relapse with few good options. The suggested algorithm is our objective evaluation of the currently existing knowledge. Hopefully, the ongoing phase II and III trials will provide us the needed chemotherapy agents in the years to come.
新诊断的恶性神经胶质瘤的标准治疗包括手术、放疗和通常的替莫唑胺化疗。对于替莫唑胺治疗失败后的复发或进展性疾病，目前尚无共识，并且化疗选择有限。
我们回顾了 2000 年 1 月至 2010 年 9 月期间进行的复发性恶性神经胶质瘤治疗的 II 期临床试验的英文文献。通过对 2000 年之前发表的关于在复发性胶质瘤中具有活性的化疗方案的文章进行回顾，对搜索结果进行了补充。
为了在普通肿瘤学环境中指导实践，根据撰写时报告的化疗的活性制定了一个算法。对肿瘤组织进行的一些分子研究可能有助于指导化疗的选择。肿瘤组织中甲基化的 MGMT 与对烷化剂如福莫司汀或其他亚硝脲类药物的敏感性增加相关。根据 MGMT 状态和骨髓储备情况，福莫司汀、贝伐单抗、贝伐单抗联合伊立替康或顺式维甲酸（cRA）的治疗可能具有价值。
不幸的是，新的和更有效的化疗药物的开发进展非常有限，这使得治疗高级别神经胶质瘤患者复发的临床医生几乎没有太多的选择。建议的算法是我们对现有知识的客观评估。希望正在进行的 II 期和 III 期试验将在未来几年为我们提供所需的化疗药物。
