İlhan HACIBEKİROĞLU, Ebru SARI, Dilşen ÇOLAK, İnanç İMAMOĞLU, Semiha URVAY, Naziyet KÖSE, Mustafa ALTINBAŞ

Gliomlara yaklaşım ve yeni tedaviler

Glioblastoma multiforme yetişkinlerde en sık görülen primer beyin tümörüdür. Standart tedaviyi tümörün güvenli aralıkta totale yakın eksizyonu, takiben radyoterapi eşliğinde temozolamid ve idame temozolamid oluşturur. Rekürrens durumunda tedavi seçenekleri sınırlıdır. Seçilmiş hasta grubunda kurtarma cerrahisi yapılabilir. Birinci basamak kemoterapi sonrası nüks hastalarda konvansiyonel tedavilerin etkileri düşüktür ve kabul edilen standart bir tedavi mevcut değildir. Bu hastalarda geleneksel olarak kullanılan ajanlar nitrozüreler, siklofosfamid, ve platin bazlı rejimler iken adjuvan tedavi sonrası ilk altı ayda nüks edenlerde veya başlangıç temozolamid tedavisini tamamlayamayan hastalarda temozolamid tekrar kullanımı denenebilir. Son yıllarda hedefe yönelik ajanlar üzerine ilgi yoğunlaşmıştır. Vasküler endotelyal büyüme faktörü inhibitörü Bevacizumab iki çalışmaya dayanarak nüks glioblastomda hızlandırılmış FDA onayı almıştır. Bir integrin reseptör inhibitörü olan Cilengitide, seçilmiş hasta grubunda nüks ve birinci basamak tedavide hastalıksız ve genel sağkalım avantajı sağlayarak kendine bu alanda yer edinecek gibi görünmektedir. Ancak nüks hastaların klinik çalışma protokollerine alınarak takip edilmeleri en iyi çözüm olacaktır.

Malignant gliomas and new treatment strategies

Glioblastoma is the most frequent primary malignant brain tumor in adults. Standard therapy consists of surgical resection to the extent that is safely feasible, followed by radiotherapy and temozolomide (TMZ) with additional maintenance TMZ. At the time of disease recurrence, few treatment options are available. For selected patients, salvage surgery is indicated. For patients progressing after prior chemotherapy, conventional chemotherapy is generally ineffective. The most commenly used agents are procarbazine, lomustine or re-challenging with temazolamide. Molecularly targeted agents have been a major focus of glioblastome treatment in recent years. Bevacizumab, a monoclonal antibody that targets vascular endothelial growth factor receptor, recently received accelerated FDA approval for recurrent glioblastome based on two studies. Cilengitide, an integrin receptor inhibitor , monotherapy is well tolerated and exhibits antitumor activity among both recurrent and newly diagnosed glioblastoma patients. There is no established chemotherapy regimen available and patients are best treated within investigational clinical protocols. There is a need for more effective therapies.

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