Nettnin Ella A, Nguyen Thien, Arana Sophia, Barros Guinle Maria Isabel, Garcia Cesar A, Gibson Erin M, Prolo Laura M
Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States.
Division of Pediatric Hematology/Oncology, Lucile Packard Children's Hospital, Palo Alto, CA, United States.
Front Oncol. 2023 Dec 20;13:1295030. doi: 10.3389/fonc.2023.1295030. eCollection 2023.
High-grade gliomas are malignant brain tumors that are characteristically hard to treat because of their nature; they grow quickly and invasively through the brain tissue and develop chemoradiation resistance in adults. There is also a distinct lack of targeted treatment options in the pediatric population for this tumor type to date. Several approaches to overcome therapeutic resistance have been explored, including targeted therapy to growth pathways (ie. EGFR and VEGF inhibitors), epigenetic modulators, and immunotherapies such as Chimeric Antigen Receptor T-cell and vaccine therapies. One new promising approach relies on the timing of chemotherapy administration based on intrinsic circadian rhythms. Recent work in glioblastoma has demonstrated temporal variations in chemosensitivity and, thus, improved survival based on treatment time of day. This may be due to intrinsic rhythms of the glioma cells, permeability of the blood brain barrier to chemotherapy agents, the tumor immune microenvironment, or another unknown mechanism. We review the literature to discuss chronotherapeutic approaches to high-grade glioma treatment, circadian regulation of the immune system and tumor microenvironment in gliomas. We further discuss how these two areas may be combined to temporally regulate and/or improve the effectiveness of immunotherapies.
高级别胶质瘤是恶性脑肿瘤,因其性质而难以治疗;它们在成人体内生长迅速且具有侵袭性,会穿过脑组织并产生放化疗耐药性。迄今为止,针对儿童群体的这种肿瘤类型,明显缺乏靶向治疗选择。人们已经探索了几种克服治疗耐药性的方法,包括针对生长途径的靶向治疗(如表皮生长因子受体和血管内皮生长因子抑制剂)、表观遗传调节剂以及嵌合抗原受体T细胞和疫苗疗法等免疫疗法。一种新的有前景的方法依赖于基于内在昼夜节律的化疗给药时间。最近在胶质母细胞瘤方面的研究表明,化疗敏感性存在时间差异,因此,根据一天中的治疗时间,生存率有所提高。这可能是由于胶质瘤细胞的内在节律、血脑屏障对化疗药物的通透性、肿瘤免疫微环境或另一种未知机制。我们回顾文献,讨论高级别胶质瘤治疗的时辰治疗方法、胶质瘤中免疫系统和肿瘤微环境的昼夜调节。我们还将进一步讨论如何将这两个领域结合起来,以便在时间上调节和/或提高免疫疗法的有效性。