A Critical Overview of Targeted Therapies for Vestibular Schwannoma

被引:22
|
作者
Tamura, Ryota [1 ]
Toda, Masahiro [1 ]
机构
[1] Keio Univ, Dept Neurosurg, Sch Med, Shinjuku Ku, 35 Shinanomachi, Tokyo 1608582, Japan
关键词
schwannoma; NF2; bevacizumab; VEGF; SH3PXD2A-HTRA1; fusion; molecular targeted therapy; NEUROFIBROMATOSIS TYPE-2; TUMOR-SUPPRESSOR; PHASE-II; GROWTH; BEVACIZUMAB; ACTIVATION; EVEROLIMUS; INHIBITION; EXPRESSION; MERLIN;
D O I
10.3390/ijms23105462
中图分类号
Q5 [生物化学]; Q7 [分子生物学];
学科分类号
071010 ; 081704 ;
摘要
Vestibular schwannoma (VS) is a benign tumor that originates from Schwann cells in the vestibular component. Surgical treatment for VS has gradually declined over the past few decades, especially for small tumors. Gamma knife radiosurgery has become an accepted treatment for VS, with a high rate of tumor control. For neurofibromatosis type 2 (NF2)-associated VS resistant to radiotherapy, vascular endothelial growth factor (VEGF)-A/VEGF receptor (VEGFR)-targeted therapy (e.g., bevacizumab) may become the first-line therapy. Recently, a clinical trial using a VEGFR1/2 peptide vaccine was also conducted in patients with progressive NF2-associated schwannomas, which was the first immunotherapeutic approach for NF2 patients. Targeted therapies for the gene product of SH3PXD2A-HTRA1 fusion may be effective for sporadic VS. Several protein kinase inhibitors could be supportive to prevent tumor progression because merlin inhibits signaling by tyrosine receptor kinases and the activation of downstream pathways, including the Ras/Raf/MEK/ERK and PI3K/Akt/mTORC1 pathways. Tumor-microenvironment-targeted therapy may be supportive for the mainstays of management. The tumor-associated macrophage is the major component of immunosuppressive cells in schwannomas. Here, we present a critical overview of targeted therapies for VS. Multimodal therapy is required to manage patients with refractory VS.
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页数:11
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