Dana-Farber/Brigham and Women's Cancer Center, Center for Neuro-Oncology, Boston, MA, USA.
Expert Opin Emerg Drugs. 2013 Jun;18(2):137-53. doi: 10.1517/14728214.2013.794784. Epub 2013 May 14.
Primary and metastatic brain tumors remain a major challenge. The most common primary adult malignant brain tumor, glioblastoma (GBM), confers a dismal prognosis as does the development of CNS metastases for most systemic malignancies. Anti-angiogenic therapy has been a major clinical research focus in neuro-oncology over the past 5 years.
Culmination of this work includes US FDA accelerated approval of bevacizumab for recurrent GBM and the completion of two placebo-controlled Phase III studies of bevacizumab for newly diagnosed GBM. A multitude of anti-angiogenics are in evaluation for neuro-oncology patients but none has thus far surpassed the therapeutic benefit of bevacizumab.
These agents demonstrate adequate safety and the majority of GBM patients derive benefit. Furthermore, their anti-permeability effect can substantially decrease tumor-associated edema leading to stable or improved neurologic function and quality of life. In particular, anti-angiogenics significantly prolong progression-free survival - a noteworthy achievement in the context of infiltrative and destructive brain tumors like GBM; however, in a manner analogous to other cancers, their impact on overall survival for GBM patients is modest at best. Despite substantial clinical research efforts, many fundamental questions regarding anti-angiogenic agents in brain tumor patients remain unanswered.
原发性和转移性脑肿瘤仍然是一个主要的挑战。最常见的成人原发性恶性脑肿瘤——胶质母细胞瘤（GBM），以及大多数系统性恶性肿瘤发展为中枢神经系统转移，都预后不良。抗血管生成治疗是过去 5 年来神经肿瘤学的主要临床研究重点。
这项工作的成果包括美国食品和药物管理局（FDA）加速批准贝伐单抗用于复发性 GBM，以及完成了两项贝伐单抗用于新诊断 GBM 的安慰剂对照 III 期研究。许多抗血管生成药物正在评估用于神经肿瘤学患者，但迄今为止，没有一种药物的疗效超过贝伐单抗。
这些药物表现出足够的安全性，大多数 GBM 患者从中受益。此外，它们的抗通透性作用可以显著减少肿瘤相关的水肿，从而稳定或改善神经功能和生活质量。特别是，抗血管生成药物显著延长了无进展生存期——这在 GBM 等浸润性和破坏性脑肿瘤的背景下是一个显著的成就；然而，与其他癌症类似，它们对 GBM 患者的总体生存影响充其量只是适度的。尽管进行了大量的临床研究工作，但脑肿瘤患者的抗血管生成药物仍有许多基本问题尚未得到解答。
