Current Role of Anti-Angiogenic Strategies for Glioblastoma

摘要: Glioblastoma, an incurable, malignant, and highly vascular tumor, is a seemingly ideal target for anti-angiogenic therapies such as bevacizumab, anti-vascular endothelial growth factor (VEGF) monoclonal antibody. Phase II trials in recurrent glioblastoma demonstrated bevacizumab was associated with clinical benefits, including decreases brain edema corticosteroids use resulting from reduced permeability, well radiographic responses 25 %–40 % of patients. In newly diagnosed disease, phase III trial (AVAglio) showed adding to standard chemoradiotherapy improved progression free survival (PFS), preservation quality life, use, but did not improve overall (OS). Another similar (RTOG 0825) found PFS OS trends, suggested that the addition resulted more frequent cognitive decline compared chemoradiotherapy. However, interpretation those findings limited by fact progressing patients were evaluated, remained longer on study arm. It possible observed represented unrecognized tumor progression, rather than deleterious effects. Regardless, even if real, it difficult ascertain how improvements life compare economic costs increased toxicities setting no benefit. Further studies disease are being conducted; preliminary results randomized favorable combination CCNU, final awaited. Meanwhile, outside realm trials, current trend appears be reserve or moderate severe neurologic symptoms, either setting. research efforts needed determine optimal candidates this treatment molecular standpoint, develop imaging tools capable accurately identifying response establish new drug combinations could result unquestionable benefit these