Buttigliero Consuelo, Bertaglia Valentina, Novello Silvia
Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy.
Transl Lung Cancer Res. 2016 Dec;5(6):610-627. doi: 10.21037/tlcr.2016.09.03.
Central nervous system (CNS) metastases are common in patients with advanced non-small cell lung cancer (NSCLC), occurring in 24% to 44% of patients in the course of their disease and confer significant morbidity and mortality. Systemic therapies have been deemed ineffective in brain metastases (BM) under the hypothesis that the blood-brain barrier (BBB) limits their delivery to the brain. Angiogenesis, which is mainly mediated by vascular endothelial growth factor (VEGF) pathway, is crucial for tumor survival, growth and invasion both in primary and metastatic brain lesions. Two major categories of agents have been developed to target this pathway: antibody-based agents and VEGF receptor tyrosine kinase inhibitors (TKIs). Clinical benefits have been shown with anti-angiogenetic therapies in the treatment of metastatic NSCLC. However, patients with CNS metastases were often excluded from trials with these agents, due to concerns about a potentially greater risk of cerebral haemorrhage and thromboembolic disease. Therefore, the overall efficacy and safety of angiogenetic agents in patients with BM from NSCLC are yet to be clarified. This paper aims to review available data about the efficacy and safety of anti-angiogenetic therapies for CNS metastases in NSCLC patients.
中枢神经系统（CNS）转移在晚期非小细胞肺癌（NSCLC）患者中很常见，在疾病过程中发生率为24%至44%，并带来显著的发病率和死亡率。在血脑屏障（BBB）限制全身治疗药物进入大脑这一假设下，全身治疗被认为对脑转移（BM）无效。血管生成主要由血管内皮生长因子（VEGF）通路介导，对原发性和转移性脑病变中的肿瘤存活、生长和侵袭至关重要。已开发出两大类靶向该通路的药物：基于抗体的药物和VEGF受体酪氨酸激酶抑制剂（TKIs）。抗血管生成疗法在转移性NSCLC治疗中已显示出临床益处。然而，由于担心脑出血和血栓栓塞性疾病的潜在风险更大，CNS转移患者通常被排除在这些药物的试验之外。因此，抗血管生成药物在NSCLC脑转移患者中的总体疗效和安全性尚待阐明。本文旨在综述NSCLC患者中枢神经系统转移抗血管生成治疗的疗效和安全性的现有数据。
