重组人血管内皮抑素在治疗头颈部恶性肿瘤中的应用进展

Application progress of recombinant human endostatin in the treatment of head and neck cancer

头颈部恶性肿瘤的治疗方式主要是以手术切除为主的综合序列治疗,但5年总生存率提高不足50%,如何进一步提高头颈部恶性肿瘤治疗成功率成为临床中亟待解决的问题。重组人血管内皮抑素是一种靶点为血管内皮细胞的抗血管生成靶向药物,具有一定的抑制肿瘤的作用。单独用药治疗恶性肿瘤并不明显优于放化疗,但联合放化疗,可以通过改变肿瘤内部血管分布,改善肿瘤内部缺氧,促使血管正常化增加放化疗效果,且不产生药物抵抗,在头颈部恶性肿瘤治疗中表现出一定的优势,有望成为一种新的肿瘤治疗方法。文献复习结果表明,重组人血管内皮抑素作用机制主要包括调节内皮细胞内外基质蛋白影响新生血管生成;作用于内皮细胞表面相关受体;逆转异常新生血管达到血管正常化;抑制低氧诱导因子,改善肿瘤区域缺氧状态;调控细胞周期,使更多的肿瘤细胞处于放射敏感期以及使血管正常化窗口增加放化疗效果。其在头颈部恶性肿瘤放化疗协同作用以及在晚期头颈部恶性肿瘤中应用效果良好,为临床医生提供一种继放化疗之后又一抗肿瘤方法。

The main treatment of head and neck cancer is comprehensive sequential treatment, but the 5-year overall survival rate is less than 50%. Strategies to further improve the curative effect of head and neck cancer are urgently needed in the clinic. Recombinant human vascular endostatin is an antiangiogenesis drug targeting vascular endothelial cells, which has a certain inhibitory effect on tumors. The treatment of malignant tumors by drugs alone is not significantly better than chemoradiation, but combined with radiotherapy and chemotherapy, it can increase the effect of radiotherapy and chemotherapy without drug resistance by changing the distribution of blood vessels, reducing oxygen and normalizing blood vessels. Head and neck tumor treatment has certain advantages. New tumor treatments are expected.The results of a literature review showed that the mechanism of action of recombinant human endostatin mainly includes regulating the matrix protein inside and outside the endothelial cells to influence neovascularization, acting on receptors related to the surface of endothelial cells, reversing abnormal neovascularization to achieve vascular normalization, inhibiting hypoxia inducible factor to improve the hypoxic status of the tumor area, and regulating the cell cycle to ensure the tumor cells are sensitive to radiation in the sensitive period, and vascular normalization can increase the effect of radiotherapy. This treatment has a good synergistic effect with radiotherapy and chemotherapy of head and neck tumors and has a good effect on advanced head and neck tumors.