Angiogenesehemmung in der Neuroonkologie: Eine vielversprechende Therapiestrategie gegen maligne Gliome

Zusammenfassung: Der Einsatz angiogenesehemmender Substanzen in der Hirntumortherapie nimmt zu. Der initialen Euphorie bezüglich der überraschend hohen Ansprechraten bei Hemmstoffen des VEGF ("vascular endothelial growth factor")-Signalwegs ist mittlerweile eine Ernüchterung gefolgt, da die progressionsfreie Zeit und das mediane Überleben langfristig nicht zufriedenstellend sind. Die Tumorprogression kann während/nach antiangiogener Therapie mit rapider klinisch-neurologischer Verschlechterung einhergehen und weist häufig einen gliomatosisähnlichen diffus-infiltrativen Phänotyp auf. Somit bestehen die aktuellen Herausforderungen darin, Kriterien für den individuellen Einsatz von Angiogenesehemmern zu definieren sowie die unter der Therapie auftretenden Resistenzmechanismen zu entschlüssel

Tumor treating fields: a novel treatment modality and its use in brain tumors.

Tumor treating fields (TTFields) are low-intensity electric fields alternating at an intermediate frequency (200kHz), which have been demonstrated to block cell division and interfere with organelle assembly. This novel treatment modality has shown promise in a variety of tumor types. It has been evaluated in randomized phase 3 trials in glioblastoma (GBM) and demonstrated to prolong progression-free survival (PFS) and overall survival (OS) when administered together with standard maintenance temozolomide (TMZ) chemotherapy in patients with newly diagnosed GBM. TTFields are continuously delivered by 4 transducer arrays consisting each of 9 insulated electrodes that are placed on the patient's shaved scalp and connected to a portable device. Here we summarize the preclinical data and mechanism of action, the available clinical data, and further outlook of this treatment modality in brain tumors and other cancer indications

Standards of care and novel approaches in the management of glioblastoma multiforme.

Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor in adults. Standard therapeutic approaches provide modest improvement in the progression-free and overall survival, necessitating the investigation of novel therapies. We review the standard treatment options for GBM and evaluate the results obtained in clinical trials for promising novel approaches, including the inhibition of angiogenesis, targeted approaches against molecular pathways, immunotherapies, and local treatment with low voltage electric fields