老年胶质母细胞瘤治疗研究进展

老年胶质母细胞瘤(glioblastoma multiform,GBM)的治疗方案尚未达成一致的共识,是目前研究的热点。在安全范围内手术全切肿瘤可改善老年GBM的预后。放疗能够延长老年GBM患者的生存期,短程低分割放疗能达到标准放疗的治疗效果,且毒副作用较小。O~6-甲基鸟嘌呤-DNA-甲基转移酶(O~6-methylguanine-DNA methyltransferase,MGMT)启动子甲基化状态在老年GBM患者中能预测替莫唑胺(temozolomide,TMZ)化疗的疗效,对于MGMT启动子甲基化的老年GBM患者,TMZ化疗能够明显延长生存期。对于一般状况较好的老年GBM患者,TMZ联合低分割放疗较单一低分割放疗能延长生存期。在临床工作中,面对老年GBM患者,需结合患者的功能状态、合并症、肿瘤分子病理特征、社会支持等综合因素制定个体化的治疗方案。     

顺铂联合替莫唑胺治疗MGMT启动子非甲基化的 复发高级别胶质瘤

目的 探讨顺铂（DDP）联合替莫唑胺（TMZ）治疗MGMT启动子非甲基化的复发高级别胶 质瘤的疗效。方法 纳入2016 年4 月30 日至2018 年3 月31 日收治55 例MGMT启动子非甲基化的复发 高级别胶质瘤,均经过手术病理证实为高级别胶质瘤（WHO Ⅲ级或Ⅳ级）和MGMT启动子非甲基化。随 访期间经头颅MRI 和（或）再次手术的病理确诊为肿瘤复发,并给予DDP联合TMZ化疗。观察患者的不 良反应和生存情况。结果 WHO Ⅲ级有效率为12.0%（3/25）,中位生存期为42 个月;WHO Ⅳ级有效率 为6.7%（2/30）,中位生存期为17 个月。总有效率为9.1%（5/55）,总生存期为19 个月。不良反应主要为骨 髓抑制、胃肠道症状和肝肾功能损伤,经对症治疗后均恢复。结论 DDP 联合TMZ 治疗MGMT 启动子 非甲基化的复发高级别胶质瘤具有一定的疗效。     

白藜芦醇对脑胶质瘤U87细胞及干细胞凋亡诱导作用

目的比较研究白黎芦醇(Res)对人脑胶质瘤U87细胞及其胶质瘤干细胞(GSC)的作用。方法膜联蛋白Ⅴ(AnnexinⅤ)和碘化丙啶(PI)染色法测定细胞凋亡;CD133标记、CD133与AnnexinⅤ/PI共标记检测GSC相对含量及GSC的凋亡;实时荧光定量逆转录-聚合酶链式反应(RT-PCR)检测mdr1基因mRNA表达,流式细胞术(FCM)测定P-糖蛋白(P-gp)的表达;集落形成法(CFU)检测细胞的自我更新和增殖能力。结果不同浓度的Res显著诱导U87细胞凋亡,抑制U87细胞集落的形成。40～160μmol/L Res作用后U87细胞群体中CD133+GSC相对含量显著增高、GSC凋亡细胞数量增加,但GSC对Res的敏感性低于U87群体细胞。Res诱导后U87细胞群体中高表达mdr1/P-gp的细胞显著增高,并与GSC含量的增高基本相一致。结论白黎芦醇可诱导脑恶性胶质瘤U87群体细胞及其干细胞凋亡。     

MGMT表达在胶质瘤对烷化剂耐药中的作用

恶性脑胶质瘤是最常见的原发性颅内恶性肿瘤,包括小分子、脂溶性、能穿过血脑屏障的烷化剂的化疗方案,使部分病人的生存期明显延长。烷化剂的化疗效果同MGMT(O6-methylguanine-DNA methyltransferase MGMT)基因启动子甲基化沉默了MGMT表达相关,因此,阻断其修复能力可使烷化剂更有效。其表达可由甲基化特异性PCR(MSP)、免疫组化(IHC)、血清MGMT活性检测等方法直接或间接测定。MGMT基因启动子甲基化水平可作为识别病人对烷化剂敏感性的指标,并以此指导临床治疗。     

胶质母细胞瘤MGMT基因启动子甲基化、MGMT蛋白表达和预后相关性分析

目的探讨脑胶质母细胞瘤中O-6-甲基鸟嘌呤-DNA甲基转移酶(MGMT)基因启动子甲基化状态和MGMT蛋白表达水平与临床预后的相关性。方法收集119例人脑胶质母细胞瘤石蜡包埋样本,提取基因组DNA并进行亚硫酸氢盐修饰,用MethyLight法检测MGMT基因启动子甲基化状态,用免疫组织化学染色法检测MGMT蛋白表达水平,对MGMT基因启动子甲基化状态和MGMT表达水平与患者预后行相关性分析。结果在119例胶质母细胞瘤样本中,有42例检测到MGMT基因启动子甲基化,甲基化发生率为35.3%(42/119例),MGMT基因启动子甲基化与无进展生存期(P=0.011)及总体生存期(P=0.036)延长相关。MGMT蛋白表达水平和临床预后无相关性(P0.05),与MGMT基因启动子甲基化状态之间也无相关性(P0.05)。结论 MGMT基因启动子甲基化与胶质母细胞瘤患者预后呈正相关,由免疫组化法测得的MGMT蛋白表达水平和预后及基因启动子甲基化之间无关联性,MGMT基因启动子甲基化状态可以作为评判预后的生物学指标之一。     

恶性脑胶质瘤MGMT基因启动子甲基化状态与患者临床预后的相关性

目的 探讨恶性脑胶质瘤组织O6-甲基鸟嘌呤-DNA-甲基转移酶(MGMT)基因启动子甲基化状态及MGMT蛋白表达与患者生存预后的关系,评价MS-MLPA技术检测MGMT基因启动子甲基化状态对脑胶质瘤化疗的意义. 方法 选择自2006至2010年南方医科大学珠江医院神经外科手术治疗且病理证实为恶性脑胶质瘤(WHOⅢ级、Ⅳ级)的39例患者为研究对象,应用免疫组化染色法检测肿瘤组织MGMT蛋白表达,应用MS-MLPA技术检测MGMT基因启动子甲基化状态,并观察患者化疗后总生存时间. 结果 肿瘤组织中MGMT蛋白表达阳性、弱阳性者与表达阴性者生存时间比较差异有统计学意义(P=0.003),MGMT蛋白表达阳性者比表达阴性者预后更差.肿瘤组织中MGMT基因启动子未甲基化者、低度过甲基化者、中度过甲基化者、高度过甲基化者生存时间两两比较差异均有统计学意义(P＜0.05),MGMT基因启动子过甲基化率越高者预后越好.MGMT蛋白表达与MGMT基因启动子甲基化状态存在统计学相关性(r=0.697,P=0.000),基因甲基化程度越高者蛋白表达越低. 结论 MGMT蛋白表达与MGMT基因启动子甲基化状态均可以作为接受烷化剂化疗的恶性胶质瘤患者生存期的预测指标.MS-MLPA技术是一种可靠的检测MGMT基因启动子甲基化状态的方法.     

IDH1突变和MGMT基因启动子甲基化在脑胶质瘤中表达及关联度分析

目的探讨脑胶质瘤中异柠檬酸脱氢酶1(isocitrate dehydrogenases 1,IDH1)突变和O6-甲基鸟嘌呤-DNA甲基转移酶(O6-methylguanine-DNA methyltransferase,MGMT)基因启动子甲基化状态及二者之间的关联性。方法收集手术切除并经病理证实的脑胶质瘤组织133例,采用巢式甲基化特异性PCR(nested methylation-specific PCR,n MSP)法和甲基化特异性PCR(methylation specific PCR,MSP)法联合变性高效液相色谱分析(denaturing high performance liquid chromatography,DHPLC)法检测脑胶质瘤中的MGMT基因启动子甲基化情况,直接测序法检测脑胶质瘤中IDH1基因的突变情况。采用χ2检验进行IDH1突变和MGMT基因启动子甲基化关联度的统计分析。结果 133例脑胶质瘤患者中MGMT基因启动子甲基化88例(66.17%),IDH1突变62例(46.62%)。IDH1突变和MGMT基因启动子甲基化存在关联(P=0.01)。结论脑胶质瘤中IDH1突变和MGMT基因启动子甲基化之间关联显著,提示两者在脑胶质瘤的发生发展中可能存在相互调节的作用;IDH1突变和MGMT基因启动子甲基化是脑胶质瘤的重要疾病相关因素。     

胶质母细胞瘤MGMT基因启动子甲基化与蛋白表达

目的 研究新发胶质母细胞瘤中肿瘤不同部位MGMT基因启动子甲基化及其蛋白表达关系及区域差异性.方法 在30例新发胶质母细胞瘤肿瘤不同部位采取2～4块标本,其中5例在术中神经导航引导下采取.甲基化特异性PCR(MSP)法检测标本中MGMT基因启动子甲基化状况,免疫组化法(IHC)检测组织切片MGMT蛋白表达情况.结果 43.56%(44/101)检测肿瘤组织中出现MGMT基因启动子甲基化,免疫组化检测(阴性,细胞弱着色＜10%或细胞无着色;弱阳性,10%≤细胞着色≤50%;强阳性,细胞着色＞50%)发现MGMT蛋白表达情况分别为阴性(32.67%),弱阳性(43.56%),强阳性(23.76%).MGMT基因启动子甲基化与其蛋白表达无明显相关性(x2=2.905,P=0.088).在肿瘤不同取材部位组织之间57%的患者(17/30)MGMT蛋白表达水平与37%患者(11/30)启动子甲基化存在不均一性.结论 MGMT基因启动子甲基化可能不是MGMT蛋白表达的惟一调节因素.同一肿瘤不同取材部位组织MGMT蛋白表达与其基因启动子甲基化水平不均一性的结果 质疑了单一取材标本的检测结果 及其对临床治疗方案选择的指导意义.     

左乙拉西坦联合替莫唑胺作用于胶质瘤细胞的体外研究

目的探讨左乙拉西坦(LEV)联合替莫唑胺(TMZ)作用于胶质瘤细胞的效果。方法采用细胞计数试剂(CCK-8)检测并计算左乙拉西坦单药或联合替莫唑胺对人胶质瘤O6-甲基鸟嘌呤DNA甲基转移酶(MGMT)阳性细胞系(T98G、U138)、MGMT阴性细胞系(SKMG-4、U87)的抑制率和替莫唑胺的半抑制浓度(IC50)。结果 LEV单药作用于胶质瘤细胞系,多表现出一定程度的肿瘤抑制作用,但达不到治疗作用,特别对U87的抑制作用更弱。LEV联合TMZ作用T98G、U138和SKMG-4后,TMZ的IC50均有不同程度下降(P0.05),但在U87上差异无统计学意义(P0.05)。结论左乙拉西坦可抑制胶质瘤细胞(MGMT阳性和阴性)增殖,并可增敏替莫唑胺对T98G、U138和SKMG-4的疗效,但对U87细胞没有增敏作用。     

榄香烯联合替莫唑胺对胶质瘤细胞株杀伤作用的研究

目的探讨榄香烯(ELE)联合替莫唑胺(TMZ)对人胶质瘤细胞株增殖抑制的影响。方法培养人胶质瘤细胞株U87、U251、U373、T98G、SKMG-4,测定计算榄香烯、替莫唑胺不同浓度单药及固定低浓度榄香烯联合不同浓度替莫唑胺处理后的细胞增殖抑制率。结果榄香烯可抑制胶质瘤细胞增殖,抗肿瘤作用具有剂量依赖性。U87、U251、U373、T98G、SKMG-4细胞株的半抑制浓度(IC50)分别为(31.36±3.17、25.53±2.97、24.01±5.58、19.56±0.18、16.32±0.88)μg/ml。在这些细胞中,替莫唑胺单药的IC50分别是(863.56±91.1、435.46±105.67、632.81±150.97、1 420.12±351.26、772.54±32.1)μg/ml。在固定低浓度榄香烯联合替莫唑胺可分别降低替莫唑胺IC50的64.66%±5.39%、36.77%±3.17%、40.04%±11.75%、48.04%±8.05%、61.03%±3.25%。结论榄香烯具有抗胶质瘤作用,与替莫唑胺联合应用可提高替莫唑胺抗胶质瘤细胞增殖效果。     

Regulation of temozolomide resistance in glioma cells via the RIP2/NF-κB/MGMT pathway

BackgroundTemozolomide (TMZ) is a first‐line chemotherapy drug for the treatment of malignant glioma and resistance to it poses a major challenge. Receptor‐interacting protein 2 (RIP2) is associated with the malignant character of cancer cells. However, it remains unclear whether RIP2 is involved in TMZ resistance in glioma.MethodsRIP2 expression was inhibited in TMZ‐resistant glioma cells and normal glioma cells by using small interfering RNA (siRNA) against RIP2. Plasmid transfection method was used to overexpress RIP2. Cell counting kit‐8 assays were performed to evaluate cell viability. Western blotting or immunofluorescence was performed to determine RIP2, NF‐κB, and MGMT expression in cells. Flow cytometry was used to investigate cell apoptosis. TMZ‐resistant glioma xenograft models were established to evaluate the role of the RIP2/NF‐κB/MGMT signaling pathway in drug resistance.ResultsWe observed that RIP2 expression was upregulated in TMZ‐resistant glioma cells, whereas silencing of RIP2 expression enhanced cellular sensitivity to TMZ. Similarly, upon the induction of RIP2 overexpression, glioma cells developed resistance to TMZ. The molecular mechanism underlying the process indicated that RIP2 can activate the NF‐κB signaling pathway and upregulate the expression of O6‐methylguanine‐DNA methyltransferase (MGMT), following which the glioma cells develop drug resistance. In the TMZ‐resistant glioma xenograft model, treatment with JSH‐23 (an NF‐κB inhibitor) and lomeguatrib (an MGMT inhibitor) could enhance the sensitivity of the transplanted tumor to TMZ.ConclusionWe report that the RIP2/NF‐κB/MGMT signaling pathway is involved in the regulation of TMZ resistance. Interference with NF‐κB or MGMT activity could constitute a novel strategy for the treatment of RIP2‐positive TMZ‐resistant glioma.     

Meningeal hemangiopericytomas: A clinicopathological study with emphasis on MGMT (O6‐methylguanine‐DNA methyltransferase) promoter methylation status

Meningeal hemangiopericytomas (HPCs) are aggressive dural‐based tumors, for which no prognostic or predictive marker has been identified. Gross total resection is treatment of choice, but not easily achieved; hence, alkylating agents like temozolomide (TMZ) are now being tried. O⁶‐methylguanine‐DNA methyltransferase (MGMT) promoter methylation has proven prognostic and predictive value in glioblastomas. This study evaluates MGMT promoter methylation in meningeal HPCs to determine its role in HPC oncogenesis and its association with patient outcome. Meningeal HPCs diagnosed between 2002 and 2011 were retrieved and clinicopathological features reviewed. MGMT promoter methylation status was assessed by methylation‐specific polymerase chain reaction (MSP) and immunohistochemistry (IHC) for MGMT protein. HPCs accounted for 1.1% of all CNS tumors. Forty cases were analyzed; the majority were adults (mean age = 41.4 years). Seventy percent were primary and 30% were recurrent tumors; 60% were grade II and 40% were grade III. MGMT promoter methylation was identified in 45% of cases, including Grade II (54.2%) and Grade III (31.3%) (P = 0.203). Promoter methylation was significantly (P = 0.035) more frequent in primary (57.1%) than in recurrent (16.7%) tumors. No correlation was noted between MGMT promoter methylation by MSP and MGMT protein expression by IHC, or with progression‐free survival. Thus, a significant proportion of HPCs demonstrate MGMT promoter methylation, suggesting possible susceptibility to TMZ. As promoter methylation is more frequent in primary tumors, TMZ may serve as a therapeutic option in residual primary tumors. Epigenetic inactivation of MGMT in HPCs necessitates the assessment of prognostic and predictive value of MGMT promoter methylation in HPCs in larger clinical trials.     

双氢青蒿素诱导胶质瘤细胞自噬作用的研究

目的 研究双氢青蒿素(DHA)抑制胶质瘤生长作用、机制及联合替莫唑胺(TMZ)的协同抗肿瘤作用.方法 选用胶质瘤细胞株10个,MTT法检测DHA持续作用72 h后细胞株半数抑制浓度(IC50);0.5 μg/ml浓度DHA联合梯度浓度TMZ作用于SKMG-4细胞株,MTT法检测IC50;MDC法荧光分析DHA作用后自噬泡形成;梯度浓度DHA作用SKMG-4,Western Blot法检测caspase-3、Beclin -1、LC3-B蛋白表达.结果 DHA抑制胶质瘤细胞生长IC50为(1.17±0.078)μg/ml-(23.568±0.796)μg/ml;在SKMG-4细胞株中,DHA实验组与空白对照相比,可见明显的自噬泡染色;Beclin-1及LC3-B表达随DHA浓度增加而增加,而cagpase-3表达无明显变化;DHA联合TMZ抑制SKMG-4生长,IC50值明显下降(P＜0.01).结论 DHA具有抗胶质瘤活性,诱导胶质瘤细胞自噬;DHA联合作用可提高TMZ的抗胶质瘤SKMG-4活性,机制可能为增强了TMZ自噬效能.

Abstract：

Objective To investigate the anti - glioma efficacy of dihydroartemisinin ( DHA) and combined with temozolomide (TMZ) on human glioma cell line in vitro. Methods The growth inhibition of DHA on 10 glioma cell lines induced by DHA treatment for 72 h was analyzed by MTT method. TMZ combined with 0. 5 μg/ml DHA, and the IC50 value was measured in SKMG - 4 cells. The autofluorescent drug monodansylcadaverine (MDC) was used to mark autophagicvacuoles. The autophagy related protein LC3 - B and Beclin - 1, and the apoptosis protein caspase - 3 were analyzed by western blot ( WB). Results The IC50 of DHA was different in ten glioma cell lines [from (1. 17 ±0. 078) μg/ml to (23. 568 ±0. 796) μg/ml]. In SKMG -4 cells, the autophagicvacuoles were detected in the DHA group, the IC50 of TMZ had significant difference with 0. 5 μg/ml DHA contrast to the control group ( P ＜ 0. 01), and the levels of LC3 - B and Beclin -1 protein were increased gradually with the increase of DHA concentration, and caspase - 3 protein has no difference. Conclusion DHA can inhibit proliferation of glioma cell lines and increase the efficacy of TMZ, and the autophagy may be the mechanism.     

白藜芦醇通过下调CD44表达抑制胶质瘤U251细胞增殖和侵袭

目的 探讨白藜芦醇对脑胶质瘤细胞增殖和侵袭的影响及可能的分子调控机制。方法 体外培养胶质瘤U251细胞,分别用浓度为0μmol/L、50μmol/L、100μmol/L、150μmol/L白藜芦醇继续培养48 h,参考Lipofectamine2000TM说明书将pcDNA3.1/CD44(CD44过表达)、pcDNA3.1（过表达对照）等质粒转染胶质瘤U251细胞并培养24 h进行后续实验。利用CCK-8法检测细胞增殖,利用Transwell实验检测细胞侵袭;RT-PCR和免疫印迹法检测细胞CD44、CyclinD1、CDK4、MMP2和MMP9的mRNA和蛋白表达。结果 白藜芦醇明显抑制U251细胞的增殖和侵袭能力（P<0.05）,而且呈浓度依赖性（P<0.05）;所以,用150μmol/L白藜芦醇进行CD44干预实验。白藜芦醇明显抑制U251细胞CD44、CyclinD1、CDK4、MMP2和MMP9的mRNA和蛋白表达（P<0.05）,而且呈浓度依赖性（P<0.05）。CD44过表达明显抑制白藜芦醇对胶质瘤U251细胞增殖和侵袭的抑制作用（P<0....     

新诊断胶质瘤MGMT基因启动子甲基化水平定量分析

目的 探讨新诊断胶质瘤O6-甲基鸟嘌呤-DNA甲基转移酶（MGMT）基因启动子甲基化（简称MGMT甲基化）水平的变化。方法 回顾性分析2016年1月至2019年6月郑州大学附属肿瘤医院神经外科收治的225例新诊断胶质瘤的临床资料,定量分析MGMT甲基化。结果 新诊断胶质瘤MGMT甲基化水平为（23.68±14.88）%,阳性率89.33%。≥40岁病人MGMT甲基化水平[（24.89±15.67）%]显著高于<40岁病人[（19.85±11.31）%;P<0.05]。少突胶质细胞瘤MGMT甲基化水平[（30.41±12.99）%]显著高于其他类型的胶质瘤[星形细胞瘤为（20.81±13.53）%、少突星形细胞瘤为（23.00±8.21）%、胶质母细胞瘤为（23.39±17.85）%;P<0.05]。胶质瘤MGMT甲基化水平与病人年龄呈正相关（r=0.135,P<0.05）,而与病人性别和肿瘤级别无明显关系（P>0.05）。结论 新诊断胶质瘤MGMT甲基化水平与病人与年龄正相关,少突胶质细胞瘤MGMT甲基化水平明显高于其他类型胶质瘤     

胶质瘤细胞GDNF基因启动子Ⅰ区甲基化水平对其基因转录的影响

目的 探讨胶质瘤细胞胶质细胞原性神经营养因子（GDNF）基因启动子Ⅰ区甲基化水平对其基因转录的影响。方法 体外培养胶质瘤U251细胞,加入不同浓度5-氮杂胞苷（浓度分别为1、5、10和20 μmol/L）干预,以加入PBS为对照。采用重亚硫酸盐测序法测定GDNF基因启动子Ⅰ区甲基化水平,RT-PCR检测GDNF mRNA的表达。结果 与PBS组相比,1 μmol/L 5-氮杂胞苷对GDNF基因启动子Ⅰ区甲基化水平无显著影响（P>0.05）,5、10和20 μmol/L 5-氮杂胞苷均显著降低其甲基化水平（P<0.05）。与PBS组相比,1 μmol/L 5-氮杂胞苷对GDNF mRNA表达水平无显著影响（P>0.05）,5 μmol/L 5-氮杂胞苷显著增加其表达水平（P<0.05）,但随着浓度进一步增加（10、20 μmol/L）,其表达水平逐渐降低。结论 5-氮杂胞苷对GDNF基因具有去甲基化作用;GDNF启动子Ⅰ区去甲基化能够增加GDNF基因的转录水平。     

人脑胶质瘤耐药细胞系SKMG-1/TMZ的建立及其耐药机制的研究

目的 建立对替莫唑胺（TMZ）耐药的胶质瘤细胞系并初步对其耐药机制进行探讨.方法 通过体外分阶段递增药物浓度诱导法使SKMG-1细胞对TMZ产生耐药性;采用细胞集落形成实验及MTT法检测SKMG-1/TMZ细胞对TMZ的耐药性;采用RT-PCR检测SKMG-1/TMZ细胞中MGMTmRNA表达情况.结果 细胞集落形成相对率显示,SKMG-1/TMZ-6细胞形成相当率是未诱导组SKMG-1细胞的4～11倍;MTT法检测显示SKMG-1/TMZ对TMZ的耐药指数为5.8;RT-PCR检测显示SKMG-1/TMZ细胞中MGMTmRNA表达上调,并可扩增出571bp的特异性片段.结论 通过分步诱导法在体外建立了一株对TMZ耐药的细胞系SKMG-1/TMZ,MGMTmRNA表达上调是其对TMZ产生耐药的机制之一.     

Tumor-inhibition effect of levetiracetam in combination with temozolomide in glioblastoma cells

Glioblastoma (GBM) is a malignant brain tumor with a poor prognosis. The standard postoperative chemotherapy is temozolomide (TMZ), which does not greatly improve survival. The DNA repair gene O-6-methylguanine-DNA methyltransferase (MGMT) contributes to the response of TMZ-induced DNA damage. The commonly prescribed antiepileptic drug levetiracetam (LEV) has been shown to enhance TMZ’s antitumor effect via inhibition of histone deacetylases (HDACs), but the therapeutic advantages of the LEV and TMZ combination remain poorly understood. Mechanisms of response to chemotherapy include apoptosis and mitotic catastrophe, and recent studies have suggested that premature senescence may also be invoked when cancer cells are exposed to therapeutic agents. In our study, we evaluated cell proliferation and premature senescence after single and combined treatments of TMZ and LEV in two GBM cell lines that differ in TMZ sensitivity caused by the absence (A172) or presence (T98) of the MGMT protein. Both LEV and TMZ reduced cell proliferation in a dose-dependent manner in A172 cells. A senescent-like phenotype, as determined by β-galactosidase activity, was induced by both TMZ and LEV. Overall, there was a greater effect following combined treatment compared to the monotherapy groups. Thus, LEV appears to have a tumor-suppressive effect and induces cellular senescence, and combined treatment of LEV and TMZ enhanced these effects. because LEV treatment results in few adverse effects, its use in GBM treatment may allow for reduction of the TMZ dose to enhance the clinical efficacy of TMZ chemotherapy and improve quality of life.