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- W2074707923 abstract "Adult glioblastoma is the most common primary brain tumour. It is characterised by substantial morbidity and mortality despite multimodal therapy with surgical resection and adjuvant radiochemotherapy as standard care. 1 Wen PY Kesari S Malignant gliomas in adults. N Engl J Med. 2008; 359: 492-507 Crossref PubMed Scopus (3192) Google Scholar The poor prognosis is largely due to the disease's high frequency of recurrence, which is indicative of its intrinsic invasive properties into the peritumoral zone. 2 Giese A Bjerkvig R Berens ME Westphal M Cost of migration: invasion of malignant gliomas and implications for treatment. J Clin Oncol. 2003; 21: 1624-1636 Crossref PubMed Scopus (924) Google Scholar Consequently, an unmet need exists to improve local control of glioblastoma beyond the margin of resection and to explore new treatment options targeted peritumouraly. Local therapies that can be applied during surgery are therefore well-suited to bridge the gap between initial surgical resection and subsequent radiochemotherapy. In The Lancet Oncology, Manfred Westphal and colleagues 3 Westphal M Ylä-Herttuala S Martin J Warnke P et al. Adenovirus-mediated gene therapy with sitimagene ceradenovec followed by intravenous ganciclovir for patients with operable high-grade glioma (ASPECT): a randomised, open-label, phase 3 trial. Lancet Oncol. 2013; (published online July 12.)http://dx.doi.org/10.1016/S1470-2045(13)70274-2 PubMed Google Scholar explore the use of so-called suicide gene therapy to address this treatment gap, describing the results of a randomised, open-label phase 3 trial (ASPECT) for the treatment of operable high-grade glioblastoma. This trial was based on previous phase 1 and phase 2 trials 4 Sandmair AM Loimas S Puranen P et al. Thymidine kinase gene therapy forhuman malignant glioma, using replication-deficient retroviruses or adenoviruses. Hum Gene Ther. 2000; 11: 2197-2205 Crossref PubMed Scopus (249) Google Scholar , 5 Puumalainen AM Vapalahti M Agrawal RS et al. Beta-galactosidase gene transfer to human malignant glioma in vivo using replication-deficient retroviruses and adenoviruses. Hum Gene Ther. 1998; 9: 1769-1774 Crossref PubMed Scopus (174) Google Scholar , 6 Immonen A Vapalahti M Tyynela K et al. AdvHSV-tk gene therapy with intravenous ganciclovir improves survival in human malignant glioma: a randomised, controlled study. Mol Ther. 2004; 10: 967-972 Summary Full Text Full Text PDF PubMed Scopus (323) Google Scholar and relies on local injection into the resection cavity of a replication-deficient adenoviral vector encoding a herpes simplex virus thymidine kinase (HSV-tk) gene to selectively eliminate any residual glioblastoma cells. The HSV-TK catalyses the conversion of a non-toxic ganciclovir prodrug into a toxic nucleotide analogue that is incorporated into the DNA of dividing cancer cells, prompting apoptosis. This approach overcomes the typical inaccessibility of glioblastoma tumour, and brain-infiltrating, cells to most systemic therapies. Moreover, preclinical studies indicate that both the HSV-tk gene-modified cells and adjacent, non-modified dividing cells are eliminated through a so-called bystander effect that enhances the overall anti-tumour effect. This bystander effect is probably mediated by intercellular trafficking of the toxic ganciclovir metabolites through gap junctions or immune mechanisms. 7 Ram Z Culver KW Oshiro EM et al. Therapy of malignant brain tumors by intratumoral implantation of retroviral vector-producing cells. Nat Med. 1997; 3: 1354-1361 Crossref PubMed Scopus (637) Google Scholar , 8 Floeth FW Shand N Bojar H et al. Local inflammation and devascularization—in vivo mechanisms of the “bystander effect” in VPC-mediated HSV-Tk/GCV gene therapy for human malignant glioma. Cancer Gene Ther. 2001; 8: 843-851 Crossref PubMed Scopus (44) Google Scholar Another advantage is that normal neurons do not proliferate and are therefore resistant to the ganciclovir metabolites, which improves the tumour selectivity of this treatment strategy. Adenovirus-mediated gene therapy with sitimagene ceradenovec followed by intravenous ganciclovir for patients with operable high-grade glioma (ASPECT): a randomised, open-label, phase 3 trialOur findings suggest that use of sitimagene ceradenovec and ganciclovir after resection can increase time to death or re-intervention in patients with newly diagnosed supratentorial glioblastoma multiforme, although the intervention did not improve overall survival. Locally delivered gene therapy for glioblastoma should be further developed, especially for patients who are unlikely to respond to standard chemotherapy. Full-Text PDF Correction to Lancet Oncol 2013; 14: 790VandenDriessche T, Chuah MK. Glioblastoma: bridging the gap with gene therapy. Lancet Oncol 2013; 14: 789–90—In this Comment, the first author's name should read “Thierry VandenDriessche”. The last sentence should read “The continuous development of these multipronged strategies represent new hope for patients and their families.” These corrections have been made to the online Comment as of Aug 27, 2013. Full-Text PDF" @default.
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- W2074707923 title "Glioblastoma: bridging the gap with gene therapy" @default.
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