Fisher Jacob P, Adamson David C
Division of Biochemistry, Southern Virginia University, Buena Vista, VA 24416, USA.
Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA 30322, USA.
Biomedicines. 2021 Mar 22;9(3):324. doi: 10.3390/biomedicines9030324.
The standard of care (SOC) for high-grade gliomas (HGG) is maximally safe surgical resection, followed by concurrent radiation therapy (RT) and temozolomide (TMZ) for 6 weeks, then adjuvant TMZ for 6 months. Before this SOC was established, glioblastoma (GBM) patients typically lived for less than one year after diagnosis, and no adjuvant chemotherapy had demonstrated significant survival benefits compared with radiation alone. In 2005, the Stupp et al. randomized controlled trial (RCT) on newly diagnosed GBM patients concluded that RT plus TMZ compared to RT alone significantly improved overall survival (OS) (14.6 vs. 12.1 months) and progression-free survival (PFS) at 6 months (PFS6) (53.9% vs. 36.4%). Outside of TMZ, there are four drugs and one device FDA-approved for the treatment of HGGs: lomustine, intravenous carmustine, carmustine wafer implants, bevacizumab (BVZ), and tumor treatment fields (TTFields). These treatments are now mainly used to treat recurrent HGGs and symptoms. TTFields is the only treatment that has been shown to improve OS (20.5 vs. 15.6 months) and PFS6 (56% vs. 37%) in comparison to the current SOC. TTFields is the newest addition to this list of FDA-approved treatments, but has not been universally accepted yet as part of SOC.
高级别胶质瘤(HGG)的标准治疗方案(SOC)是进行最大程度安全的手术切除,随后进行6周的同步放疗(RT)和替莫唑胺(TMZ)治疗,然后进行6个月的辅助TMZ治疗。在确立该标准治疗方案之前,胶质母细胞瘤(GBM)患者在确诊后通常存活时间不到一年,并且与单纯放疗相比,没有辅助化疗显示出显著的生存获益。2005年,Stupp等人针对新诊断GBM患者的随机对照试验(RCT)得出结论,与单纯放疗相比,RT联合TMZ显著改善了总生存期(OS)(14.6个月对12.1个月)和6个月时的无进展生存期(PFS)(PFS6)(53.9%对36.4%)。除TMZ外,有四种药物和一种设备获美国食品药品监督管理局(FDA)批准用于治疗HGG:洛莫司汀、静脉注射卡莫司汀、卡莫司汀晶片植入物、贝伐单抗(BVZ)和肿瘤治疗电场(TTFields)。这些治疗方法现在主要用于治疗复发性HGG和症状。与当前的标准治疗方案相比,TTFields是唯一已被证明可改善OS(20.5个月对15.6个月)和PFS6(56%对37%)的治疗方法。TTFields是FDA批准的治疗方法列表中的最新成员,但尚未被普遍接受作为标准治疗方案的一部分。