Medical management of meningioma in the era of precision medicine
Medical management of meningioma in the era of precision medicine
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DOI：
10.3171/2018.1.focus17754
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发表时间：
2018-04-01
影响因子：
4.1
通讯作者：
Dunn, Ian F.
中科院分区：
文献类型：
--
作者：
Gupta, Saksham;Bi, Wenya Linda;Dunn, Ian F.
手术治疗大多数脑膜瘤，但少数肿瘤复发和进展后切除。脑膜瘤药物治疗的最初试验使用非特异性细胞毒性化疗。脑膜瘤上激素受体的存在，开启了模拟脑膜瘤药物的试验。虽然这些试验扩大了对脑膜瘤的临床认识，但它们最终在治疗侵袭性病变方面的疗效有限。随后对失调蛋白和基因组异常的检测激发了针对脑膜瘤中观察到的特定生物学紊乱的治疗研究。这些进展导致了靶向激酶抑制剂和免疫疗法的试验，以及这些药物与化疗的组合。目前正在招募参与者的前瞻性试验正在测试脑膜瘤的各种医学疗法，一些研究现在要求存在特定的蛋白质改变或基因突变作为入选标准。随着对脑膜瘤独特性和异质性的认识不断加深，将继续刺激新的药物治疗方法的发展，以对抗侵袭性肿瘤。
Surgery is curative for most meningiomas, but a minority of these tumors recur and progress after resection. Initial trials of medical therapies for meningioma utilized nonspecific cytotoxic chemotherapies. The presence of hormone receptors on meningioma ushered in trials of hormone-mimicking agents. While these trials expanded clinical understanding of meningioma, they ultimately had limited efficacy in managing aggressive lesions. Subsequent detection of misregulated proteins and genomic aberrancies motivated the study of therapies targeting specific biological disturbances observed in meningioma. These advances led to trials of targeted kinase inhibitors and immunotherapies, as well as combinations of these agents together with chemotherapies. Prospective trials currently recruiting participants are testing a diverse range of medical therapies for meningioma, and some studies now require the presence of a specific protein alteration or genetic mutation as an inclusion criterion. Increasing understanding of the unique and heterogeneous nature of meningiomas will continue to spur the development of novel medical therapies for the arsenal against aggressive tumors.