Zaviralci angiogeneze v zdravljenju možganskih tumorjev Angiogenesis inhibitors in brain tumor treatment

Abstract

Maligni gliomi so po histologiji in po odgovoru na zdravljenje heterogena skupina možganskih tumorjev. Standardno zdravljenje glioblastomov je kombinacija obsevanja in konkomitantne kemoterapije s temozolomidom. Antiangiogena strategija predstavlja nov pristop v zdravljenju malignih gliomov, saj so to zelo dobro ožiljeni tumorji. Predklinični podatki kažejo, da je rast teh tumorjev močno odvisna od nastajanja novih žil, te pa spodbujajo dejavniki, ki jih izloča tumor, med njimi tudi endotelni žilni rastni dejavnik (VEGF). Bevacizumab je humanizirano monoklonsko protitelo, ki veže VEGF in je dokazano učinkovit pri številnih solidnih tumorjih. V monoterapiji ali v kombinaciji s citostatiki je učinkovit tudi v zdravljenju glioblastomov, kar so pokazali rezultati kliničnih raziskav. Skupaj z učinkovitostjo zdravljenja se izboljšajo kognitivne funkcije, zmanjša se potreba po kortikosteroidih in izboljša se kakovost življenja. Bevacizumab predstavlja novo možnost zdravljenja bolnikov, pri katerih se glioblastom ponovi oz. napreduje.

Abstract (Eng)

Considering the histology of malignant gliomas and their response to treatment, they are regarded as a heterogenous group of brain tumors. Standard treatment is a combination of irradiation and concomitant chemotherapy with temozolomide. A new approach to the treatment of malignant gliomas is antiangiogenic strategy because these tumors are highly vasculated. Preclinical data show that the growth of these tumors depends on the onset of new blood vessels which is stimulated by various factors, such as VEGF (vascular endothelial growth factor), produced by the tumor itself. Bevacizumab is a humanized monoclonal antibody that binds to VEGF. It has been proved to be efficient the treatment of numerous solid tumors. Moreover, bevacizumab is efficient also in the treatment of glioblastomas, applied as monotherapy or in combination with cytostatics, which has been confirmed by the results of several clinical studies. In addition to its efficiency in the treatment glioblastomas, it has also been found to have the capacity of improving the patients' cognitive functions, reducing their need for corticosteroids, thereby also improving their quality of life. Bevacizumab offers a new potential in the treatment of recurrent or advanced glioblastoma.