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前庭神经鞘瘤的药物治疗前景

Prospects of Drug Therapy of Vestibular Schwannoma

  • 摘要: 前庭神经鞘瘤(vestibular schwannoma, VS)是中枢神经系统最常见的良性肿瘤之一。目前主要采用手术治疗、立体定向放射治疗及随访观察等,缺少可用于VS的药物治疗。虽然手术技术相对成熟,但并发症无法完全避免;且不同病例生长速度迥异,对放射治疗的敏感性也存在较大差异。随着分子生物学研究的不断深入,VS的生长机制研究大多聚焦于神经纤维蛋白2基因(neurofibromin 2, NF2)和merlin蛋白的相关上下游和受体蛋白酪氨酸激酶(receptor protein tyrosine kinase, RTK)、血管内皮生长因子受体(vascular endothelial growth factor receptor, VEGFR)、雷帕霉素靶蛋白复合物1(mammalian target of rapamycin complex 1, mTORC1)、血小板衍生生长因子受体(platelet derived growth factor receptor, PDGFR)等相应靶点。已报道的研究提示有相当多的药物对VS细胞的增殖都有抑制作用。虽然大部分研究都还在体外细胞实验和/或动物实验阶段,少部分进入临床Ⅰ~Ⅱ期研究,尚不能导向临床治疗;但据此可以全面了解VS药物治疗的现状和前景,有助于后续研究的开展。

     

    Abstract: Vestibular schwannoma (VS) is one of the most common types of benign tumors of the central nervous system. At present, the prevailing treatment methods of VS include surgery, stereotactic radiotherapy, and follow-up observation, etc. However, there is still no drug therapy available for treating VS. Although the surgical technique is relatively mature, the complications cannot be completely avoided. Furthermore, both the growth rate of different cases and patients’ sensitivity to radiotherapy vary greatly. With the constant progress made in molecular biology research, most of the studies on the growth mechanism of VS focus on the upstream and downstream of neurofibromin 2 (NF2) gene and merlin protein, and a number of corresponding targets, including receptor protein tyrosine kinase (RTK), vascular endothelial growth factor receptor (VEGFR), mammalian target of rapamycin complex 1 (mTORC1) and platelet derived growth factor receptor (PDGFR). It has been reported in some studies that quite a few drugs could inhibit the proliferation of VS cells. Most of the studies are still in the stage of in vitro cell experiment and/or animal experiment. A small number of studies have entered phase Ⅰ and phase Ⅱ clinical trials, but have not led to any clinical treatment yet. This paper provides a comprehensive understanding of the current status and the prospects of drug therapies of VS, which is conducive to the development of subsequent research.

     

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