Department of Neurology and Neurological Surgery, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1023, USA.
Curr Opin Oncol. 2012 Nov;24(6):666-71. doi: 10.1097/CCO.0b013e328356364d.
Outline current chemotherapy and targeted therapy treatments for intracranial meningiomas.
At present, there is no defined role for adjuvant chemotherapy for meningioma of any grade following initial diagnosis. In the subpopulation of patients with an unresectable meningioma and refractory to radiotherapy, hormonal chemotherapy-targeted therapy may be prescribed. Notwithstanding limited data, hydroxyurea, somatostatin analogues and interferon-α have been modestly successful in patients with recurrent meningiomas. Emerging targeted therapies, particularly angiogenic inhibitors, may prove useful in refractory meningiomas as recently demonstrated with sunitinib and novel somatostatin analogues.
A number of challenges are apparent with respect to the use of chemotherapy or targeted therapy for intracranial meningioma. First, there is very limited published literature that provides compelling evidence from which to determine appropriate therapy. Second, there is a paucity of clinical trials for patients with recurrent meningioma. Third, there remains a lack of agreement or standardization as to what constitutes a meaningful response to medical therapy recognizing these metrics differ between low-grade and high-grade recurrent meningioma. As a consequence, there remains a significant unmet need in neuro-oncology for defining the role of chemotherapy or targeted therapy in recurrent meningioma.
概述颅内脑膜瘤的当前化疗和靶向治疗方案。
目前,对于任何分级的初诊脑膜瘤,辅助化疗的作用尚未明确。对于无法切除且对放疗有抗性的脑膜瘤患者亚群,可以开具激素化疗-靶向治疗。尽管数据有限,但羟基脲、生长抑素类似物和干扰素-α 在复发性脑膜瘤患者中取得了一定的成功。新兴的靶向治疗方法,特别是血管生成抑制剂,可能对难治性脑膜瘤有用,最近的研究表明舒尼替尼和新型生长抑素类似物有效。
对于颅内脑膜瘤使用化疗或靶向治疗存在诸多挑战。首先,文献资料非常有限,缺乏有力证据来确定合适的治疗方案。其次,复发性脑膜瘤患者的临床试验非常有限。第三,对于何种程度的医疗治疗反应才算有意义,仍然缺乏共识或标准化,因为这些指标在低级别和高级别复发性脑膜瘤之间存在差异。因此,神经肿瘤学领域仍然存在显著的未满足需求,需要确定化疗或靶向治疗在复发性脑膜瘤中的作用。