Department of Biosciences & Bioengineering, Indian Institute of Technology, Mumbai, India.
Department of Radiation Oncology, Tata Memorial Center, Mumbai, Maharashtra, India.
Int Rev Immunol. 2022;41(6):582-605. doi: 10.1080/08830185.2022.2101647. Epub 2022 Aug 8.
The aggressive and recurrent nature of glioblastoma is multifactorial and has been attributed to its biological heterogeneity, dysfunctional metabolic signaling pathways, rigid blood-brain barrier, inherent resistance to standard therapy due to the stemness property of the gliomas cells, immunosuppressive tumor microenvironment, hypoxia and neoangiogenesis which are very well orchestrated and create the tumor's own highly pro-tumorigenic milieu. Once the relay of events starts amongst these components, eventually it becomes difficult to control the cascade using only the balanced contemporary care of treatment consisting of maximal resection, radiotherapy and chemotherapy with temozolamide. Over the past few decades, implementation of contemporary treatment modalities has shown benefit to some extent, but no significant overall survival benefit is achieved. Therefore, there is an unmet need for advanced multifaceted combinatorial strategies. Recent advances in molecular biology, development of innovative therapeutics and novel delivery platforms over the years has resulted in a paradigm shift in gliomas therapeutics. Decades of research has led to emergence of several treatment molecules, including immunotherapies such as immune checkpoint blockade, oncolytic virotherapy, adoptive cell therapy, nanoparticles, CED and BNCT, each with the unique proficiency to overcome the mentioned challenges, present research. Recent years are seeing innovative combinatorial strategies to overcome the multifactorial resistance put forth by the GBM cell and its TME. This review discusses the contemporary and the investigational combinatorial strategies being employed to treat GBM and summarizes the evidence accumulated till date.
胶质母细胞瘤的侵袭性和复发性是多因素的,其原因在于其生物学异质性、代谢信号通路功能障碍、刚性血脑屏障、由于胶质瘤细胞的干性而对标准治疗产生固有耐药性、免疫抑制性肿瘤微环境、缺氧和新生血管形成,这些因素非常协调,形成了肿瘤自身高度促瘤的环境。一旦这些成分之间的事件传递开始,最终仅使用包括最大限度切除、放疗和替莫唑胺化疗在内的平衡当代治疗来控制级联反应就变得非常困难。在过去的几十年中,当代治疗方式的实施在一定程度上显示出了益处,但并没有实现显著的总体生存获益。因此,需要先进的多方面组合策略。近年来,分子生物学的进展、创新疗法的开发和新型递药平台的出现,导致了胶质瘤治疗的范式转变。几十年的研究导致了几种治疗分子的出现,包括免疫疗法,如免疫检查点阻断、溶瘤病毒治疗、过继细胞治疗、纳米颗粒、CED 和 BNCT,每种方法都具有独特的优势来克服上述挑战,目前的研究。近年来,人们提出了创新性的组合策略来克服 GBM 细胞及其 TME 提出的多因素耐药性。本文讨论了目前正在使用的治疗 GBM 的组合策略和正在研究的组合策略,并总结了迄今为止积累的证据。