Daneshimehr Fatemeh, Barabadi Zahra, Abdolahi Shahrokh, Soleimani Masoud, Verdi Javad, Ebrahimi-Barough Somayeh, Ai Jafar
Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Department of Tissue Engineering and Biomaterials, School of Advanced Medical Sciences and Technologies, Hamadan University of Medical Sciences, Hamadan, Iran.
Cell J. 2022 Oct 1;24(10):555-568. doi: 10.22074/cellj.2022.8154.
Angiogenesis is a characteristic of glioblastoma (GBM), the most fatal and therapeutic-resistant brain tumor. Highly expressed angiogenic cytokines and proliferated microvascular system made anti-angiogenesis treatments a thoroughly plausible approach for GBM treatment. Many trials have proved to be not only as a safe but also as an effective approach in GBM retardation in a certain time window as seen in radiographic response rates; however, they have failed to implement significant improvements in clinical manifestation whether alone or in combination with radio/chemotherapy. Bevasizumab, an anti-vascular endothelial growth factor-A (VEGF-A) antibody, is the only agent that exerts meaningful clinical influence by improving progression-free survival (PFS) and partially alleviate clinical symptoms, nevertheless, it could not prolong the overall survival (OS) in patients with GBM. The data generated from phase II trials clearly revealed a correlation between elevated reperfusion, subsequent to vascular normalization induction, and improved clinical outcomes which explicitly indicates anti-angiogenesis treatments are beneficial. In order to prolong these initial benefits observed in a certain period of time after anti-angiogenesis targeting, some aspects of the therapy should be tackled: recognition of other bypass angiogenesis pathways activated following antiangiogenesis therapy, identification of probable pathways that induce insensitivity to shortage of blood supply, and classifying the patients by mapping their GBM-related gene profile as biomarkers to predict their responsiveness to therapy. Herein, the molecular basis of brain vasculature development in normal and tumoral conditions is briefly discussed and it is explained how "vascular normalization" concept opened a window to a better comprehension of some adverse effects observed in anti-angiogenesis therapy in clinical condition. Then, the most targeted angiogenesis pathways focused on ligand/receptor interactions in GBM clinical trials are reviewed. Lastly, different targeting strategies applied in anti-angiogenesis treatment are discussed.
血管生成是胶质母细胞瘤(GBM)的一个特征,GBM是最致命且具有治疗抗性的脑肿瘤。血管生成细胞因子的高表达和微血管系统的增殖使得抗血管生成治疗成为GBM治疗一种完全可行的方法。许多试验已证明,在一定时间窗内,抗血管生成治疗不仅是一种安全的方法,而且在延缓GBM进展方面是有效的,如影像学反应率所示;然而,无论单独使用还是与放疗/化疗联合使用,它们都未能在临床表现上实现显著改善。贝伐单抗是一种抗血管内皮生长因子-A(VEGF-A)抗体,是唯一一种通过改善无进展生存期(PFS)并部分缓解临床症状而发挥有意义临床影响的药物,然而,它并不能延长GBM患者的总生存期(OS)。II期试验产生的数据清楚地揭示了血管正常化诱导后再灌注升高与改善的临床结果之间的相关性,这明确表明抗血管生成治疗是有益的。为了延长在抗血管生成靶向治疗后的一段时间内观察到的这些初始益处,应解决治疗的一些方面:识别抗血管生成治疗后激活的其他旁路血管生成途径,确定可能导致对血液供应不足不敏感的途径,并通过绘制与GBM相关的基因图谱作为生物标志物对患者进行分类,以预测他们对治疗的反应。在此,简要讨论了正常和肿瘤情况下脑脉管系统发育的分子基础,并解释了“血管正常化”概念如何为更好地理解临床抗血管生成治疗中观察到的一些不良反应打开了一扇窗。然后,回顾了GBM临床试验中最受关注的靶向血管生成途径,这些途径聚焦于配体/受体相互作用。最后,讨论了抗血管生成治疗中应用的不同靶向策略。