New Strategies in Glioblastoma: Exploiting the New Biology
Cet article passe en revue les perspectives thérapeutiques offertes par les travaux récents sur les mécanismes biologiques des glioblastomes
Glioblastoma is one of the deadliest human cancers. There have been few significant therapeutic advances in the field over the last two decades with median survival of only about 15 months despite aggressive neurosurgery, radiation and chemotherapy. Nevertheless, the last 5 years has seen an explosion in our understanding of the genetic and molecular underpinnings of these tumors leading to renewed optimism about potential new therapeutic approaches. Several of the most promising new approaches include oncogenic signal transduction inhibition, angiogenesis inhibition, targeting canonical stem cell pathways in glioblastoma stem cells and immunotherapy. As promising as many of these approaches appear, they have yet to impact on the natural history of the disease or on patient long-term outcome. Nevertheless, it is hoped with time such approaches will lead to more effective treatments but issues such as the unique biology and anatomy of the central nervous system (CNS), impaired drug delivery, poor preclinical models with resultant non-predictive preclinical screening and poor clinical trial design potentially impede the rapid development of such new therapies. In this paper, we will review the excitement and challenges that face the development of effective new treatments that exploit this new biology.