New Horizons in the Management of Glioblastoma Multiforme: the End of the Beginning?

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J Tsang

Hong Kong J Radiol 2010;13(Suppl):S29-32

Glioblastoma multiforme is a highly invasive and aggressive brain tumour. It is the most commonly seen glioma with fast-growing features, being a devastating disease with no clear causation and no means of early detection. Less than 10% of glioblastoma multiforme patients survive more than 5 years after diagnosis. Current standard treatment includes maximal safe surgical resection and adjuvant concurrent chemo-irradiation with temozolomide followed by adjuvant temozolomide. Resistance to standard therapy still develops however, suggesting that glioblastoma multiforme cells are capable of switching their dependency from one signalling pathway to an alternative. Glioblastoma multiforme is a highly vascularised disease, in which angiogenesis plays an important role contributing to its progression and deadly course. Recently, therapies with agents targeting the vascular endothelial growth factor and vascular endothelial growth factor receptor have shown clinical benefits in patients with recurrent glioblastoma multiforme. It is indeed important to identify novel angiogenic factors that play essential roles in tumour angiogenesis and glioblastoma multiforme progression. This paper gives an overview of the management of glioblastoma multiforme including new treatments that are available, touches upon potential new therapies based on the aforesaid understanding, and discusses the promise and challenges of achieving better outcomes in this patient group.





多形性膠質母細胞瘤是大腦最常見的膠質瘤,侵略性強、生長速度快、病情短,而且無明顯病因, 亦不易及早察覺。診斷後此病的五年生存率小於10%。目前的標準療法包括在安全情況下盡可能切 除腫瘤組織,同時給予同步替莫唑胺(temozolomide)結合放射治療,再施以替莫唑胺輔助化療。對 這種標準療法仍會出現抗效性,證明多形性膠質母細胞瘤可以轉換利用不同的訊號途徑。多形性膠 質母細胞瘤有高度增生血管,而血管增生可引致病情急速惡化。最近有研究指出利用針對血管內皮 生長因子(VEGF)及VEGF受體的治療對多形性膠質母細胞瘤復發的病人有臨床幫助。找出令多形 性膠質母細胞瘤形成新增血管和惡化的新的腫瘤促血管生成因子相當重要。本文介紹治療多形性膠 質母細胞瘤的不同方法,包括現有的一些新療法,又提及有潛在價值的嶄新療法,並討論提升療效 的展望與及需要面對的挑戰。