Hoosemans Linde, Vooijs Marc, Hoeben Ann
Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands.
Department of Medical Oncology, GROW School for Oncology and Reproduction, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands.
Cancers (Basel). 2024 Aug 29;16(17):3021. doi: 10.3390/cancers16173021.
Glioblastoma (GBM) is the most prevalent central nervous system tumour (CNS). Patients with GBM have a dismal prognosis of 15 months, despite an intensive treatment schedule consisting of surgery, chemoradiation and concurrent chemotherapy. In the last decades, many trials have been performed investigating small molecule inhibitors, which target specific genes involved in tumorigenesis. So far, these trials have been unsuccessful, and standard of care for GBM patients has remained the same since 2005. This review gives an overview of trials investigating small molecule inhibitors on their own, combined with chemotherapy or other small molecule inhibitors. We discuss possible resistance mechanisms in GBM, focussing on intra- and intertumoral heterogeneity, bypass mechanisms and the influence of the tumour microenvironment. Moreover, we emphasise how combining inhibitors can help overcome these resistance mechanisms. We also address strategies for improving trial outcomes through modifications to their design. In summary, this review aims to elucidate different resistance mechanisms against small molecule inhibitors, highlighting their significance in the search for novel therapeutic combinations to improve the overall survival of GBM patients.
胶质母细胞瘤(GBM)是最常见的中枢神经系统肿瘤(CNS)。尽管采用了包括手术、放化疗和同步化疗在内的强化治疗方案,但GBM患者的预后仍然很差,生存期仅为15个月。在过去几十年中,已经进行了许多试验来研究小分子抑制剂,这些抑制剂靶向参与肿瘤发生的特定基因。到目前为止,这些试验都没有成功,自2005年以来,GBM患者的标准治疗方案一直没有改变。这篇综述概述了单独研究小分子抑制剂、将其与化疗或其他小分子抑制剂联合使用的试验。我们讨论了GBM中可能的耐药机制,重点关注肿瘤内和肿瘤间的异质性、旁路机制以及肿瘤微环境的影响。此外,我们强调了联合使用抑制剂如何有助于克服这些耐药机制。我们还讨论了通过改进试验设计来提高试验结果的策略。总之,这篇综述旨在阐明针对小分子抑制剂的不同耐药机制,强调它们在寻找新的治疗组合以提高GBM患者总生存期方面的重要性。