Enhanced MGMT expression contributes to temozolomide resistance in glioma stem-like cells

O6-methylguanine DNA methyltransferase （MGMT） can remove DNA alkylation adducts, thereby repairing damaged DNA and contributing to the drug resistance of gliomas to alkylating agents. In addition, glioma stem-like cells （GSCs） have been demonstrated to be involved in the recurrence and treatment resistance of gliomas. In this study, we aimed to investigate MGMT expression and regulatory mechanisms in GSCs and the association of MGMT with temozolomide （TMZ） sensitivity. GSCs were enriched from one MGMT-positive cell line （SF-767） and 7 MGMT-negative cell lines （U251, SKMG-4, SKMG-1, SF295, U87, MGR1, and MGR2） through serum-free clone culture. GSCs from the U251G, SKMG-4G, SF295G, and SKMG-1G cell lines became MGMT-positive, but those from the U87G, MGR1G, and MGR2G cell lines remained MGMT-negative. However, aJl the GSCs and their parental glJoma cell lines were positive for nuclear factor-KB （NF-KB）. In addition, GSCs were more resistant to TMZ than their parental glioma cell lines （P 〈 0.05）. However, there was no significant difference in the 50% inhibition concentration （ICo） of TMZ between MGMT-positive and MGMT-negatJve GSCs （P 〉 0.05）. When we treated the MGMT-positive GSCs with TMZ plus MG-132 （an NF-KB inhibitor）, the antitumor activity was significantly enhanced compared to that of GSCs treated with TMZ alone （P 〈 0.05）. Furthermore, we found that MGMT expression decreased through the down-regulation of NF-KB expression by MG-132. Our results show that MG-132 may inhibit NF-KB expression and further decrease MGMT expression, resulting in a synergistic effect on MGMT-positive GSCs. These results indicate that enhanced MGMT expression contributes to TMZ resistance in MGMT-positive GSCs.     

姜黄素抑制MGMT基因表达增强恶性胶质瘤对替莫唑胺化疗的敏感性

目的 探讨姜黄素对高水平O6-甲基鸟嘌呤DNA甲基转移酶(MGMT)的调控作用及其对恶性胶质瘤化疗敏感性的影响.方法 通过实时荧光定量PCR(qRT-PCR)测定姜黄素、替莫唑胺单药和二者联合对MGMT表达阳性恶性胶质瘤C6及U87细胞株、复发或耐药恶性胶质瘤原代细胞MGMT表达水平的影响.CCK-8检测细胞增殖变化,流式细胞检测细胞凋亡的变化.结果 与姜黄素(C6:0.64 ±0.03;U87:0.63±0.06;原代细胞:0.51±0.07)、替莫唑胺(C6:0.53 ±0.06;U87:0.51±0.04;原代细胞:0.79±0.03)单药比较,姜黄素、替莫唑胺二者联合(C6:0.14±0.01;U87:0.12±0.03;原代细胞:0.29±0.02)能明显降低C6及U87细胞株、复发或耐药恶性胶质瘤原代细胞株中MGMT的表达,组间差异具有统计学意义(C6:F=23.675,P=0.006;U87:F=29.021,P=0.001;原代细胞株:F=25.534,P=0.001).与姜黄素、替莫唑胺单药比较,二者联合均能抑制细胞的增殖,半数抑制浓度(IC50)值降低,差异具有统计学意义(C6:F=6.731,P=0.012;U87:F=17.321,P=0.008;原代细胞株:F=18.857,P=0.007).姜黄素和替莫唑胺二者联合作用后细胞的凋亡率较单药作用后明显增加,组间差异具有统计学意义(C6:F=25.871,P=0.001;U87:F=6.847,P=0.009;原代细胞株:F =36.641,P=0.000).结论 姜黄素与替莫唑胺能协同降低MGMT的表达,增强恶性胶质瘤对替莫唑胺的化疗敏感性,为替莫唑胺耐药的恶性胶质瘤的治疗提供新的思路和方法.     

lncRNA POU3F3 通过调节MGMT的表达影响高级别脑胶质瘤细胞对替莫唑胺耐药

[摘要] 目的：探讨lncRNA POU3F3 通过调节MGMT的表达影响高级别脑胶质瘤细胞对替莫唑胺(temozolomide,TMZ)耐药及其作用机制。方法：选取2016 年1 月至2018 年1 月北京大学国际医院神经外科收治的60 例患者组织标本,其中,脑外伤患者12 例（正常组）、初发高级别脑胶质瘤患者30 例（初发组）、复发高级别脑胶质瘤患者[复发组,已经接受了手术治疗+TMZ综合治疗再次复发的人群]18 例。采用1、2、4 及8 μg/ml TMZ诱导U251 细胞并维持正常生长1 周以构建抵抗U251 TMZ耐药细胞系（U251 TMZ-resistance,U251-TR）;正常组采用相同体积的0.9%生理盐水处理U251 细胞。采用qPCR和Wb检测正常脑组织及神经胶质瘤细胞中POU3F3 和甲基鸟嘌呤-DNA甲基转移酶（methylguanine DNA methyltransferase,MGMT）mRNA和蛋白的表达水平。慢病毒转染构建稳定干扰POU3F3 的U251-TR细胞系（U251-TR stable interference POU3F3,U251-TR siPOU3F3）,MTT法验证U251-TR 细胞并检测细胞TMZ IC50值,Wb检测细胞中MGMT蛋白的表达水平。结果：与正常组及初发组比较,复发组POU3F3 表达显著增高（P<0.01）,U251-TR细胞TMZ IC50值显著高于U251 细胞（P<0.01）,U251-TR siPOU3F3 细胞TMZ IC50值显著低于U251-TR细胞（均P<0.01）,但高于U251 细胞（P<0.01）;U251-TR细胞POU3F3 及MGMT mRNA和蛋白的表达水平均高于U251 细胞（均P<0.01）,U251-TR siPOU3F3 细胞POU3F3 及MGMT mRNA和蛋白表达水平均低于U251-TR 细胞（均P<0.01）。结论：lncRNA POU3F3 是促进高级别脑胶质瘤细胞TMZ耐药性的关键因素,可能对临床上TMZ耐药的研究有一定的意义。     

MGMT启动子甲基化对神经胶质瘤患者治疗及预后的临床意义

目前以替莫唑胺（temozolomide,TMZ）为基础的化疗已成为神经胶质瘤术后辅助治疗的标准方案,然而TMZ对部分患者疗效欠佳。DNA修复蛋白O6-甲基鸟嘌呤-DNA甲基转移酶（O6-methylguanine-DNA methyltransferase,MGMT）启动子甲基化是胶质瘤患者的重要分子标志物,与胶质瘤预后及烷基化药物如TMZ的耐药有关。在新诊断的胶质母细胞瘤中,MGMT启动子甲基化已成为独立预后指标。MGMT启动子甲基化是抑制MGMT蛋白表达的关键机制,可抑制DNA修复,增加TMZ化疗敏感性。本文综述了MGMT启动子甲基化与神经胶质瘤患者预后、疗效的最新数据及临床试验,对MGMT启动子甲基化在临床中的应用进行总结,以期为神经胶质瘤患者的个体化治疗提供参考。      

U251源性脑肿瘤干细胞的耐药性及耐药酶的表达

背景与目的：从胶质瘤中分离的肿瘤干细胞（cancer stem cells,CSCs）是胶质瘤的种子细胞和复发的源泉,它们不能被有效的杀死导致胶质瘤的预后不理想。本研究旨在探讨胶质瘤来源的肿瘤干细胞对化疗药物的耐药性及相关耐药酶的表达。方法：用免疫磁珠法从U251细胞中分选肿瘤干细胞（U251-CSC）后继续培养;MTT比色试验法观察化疗药物替尼泊苷（Vm-26）、卡莫司汀（BCNU）和顺铂（DDP）对U251和U251-CSC的增殖抑制作用,流式细胞仪检测3种化疗药物引起的细胞凋亡;Western blot免疫印迹法检测3种耐药酶LRP、MGMT和TopoⅡα的表达。结果：在3种药物作用下,U251的生长抑制比U251-CSC明显,U251的细胞凋亡率高于U251-CSC;U251-CSC表达LRP、MGMT和TopoⅡα的强度高于U251。结论：胶质瘤肿瘤干细胞对化疗药物Vm-26、BCNU和DDP有高耐药性,原因可能是肿瘤干细胞高表达耐药酶LRP、MGMT和TopoⅡα。     

胶质瘤干细胞血管生成拟态现象的体外研究

背景与目的：血管生成拟态是存在于恶性肿瘤中的,由肿瘤细胞而不是内皮细胞围成的管腔样结构,管腔中有血液流通并参与肿瘤微循环。我们采用体外三维培养模型来观察对比不同来源的胶质瘤干细胞血管生成拟态现象。方法：采用悬浮克隆球形成法诱导获得胶质瘤干细胞,应用胶质瘤干细胞相关分子标记免疫荧光技术鉴定及胶质瘤干细胞裸鼠移植成瘤试验证实已诱导获取的胶质瘤干细胞;采用体外三维培养模型来观察胶质瘤干细胞体外形成血管生成拟态现象。结果：成功获取6种不同来源的胶质瘤干细胞：GSC-1、GSC-2（来源于临床胶质母细胞瘤标本）和SKMG-4G、SKMG-1G、SF-295G、SF-767G（分别来源于胶质瘤细胞系SKMG-4、SKMG-1、SF-295、SF-767）。体外三维培养模型中,拟态管腔分圆形、多边形和三角形3种。GSC-1和SKMG-4G能形成典型的拟态管腔;SKMG-1G和SF-295G只能形成过渡性的非典型的拟态管腔;而GSC-2和SF-767G不能形成拟态管腔。结论：不同来源的胶质瘤干细胞拟态血管形成的能力不同,形态也各异。     

替莫唑胺联合干扰素α/β治疗胶质瘤移植瘤的实验研究

背景与目的:6-氧甲基鸟嘌呤-DNA甲基转移酶(06-methylguanine-DNA-methyl transferase,MGMT)是肿瘤对甲基化类药物耐药的重要原因之一.替莫唑胺(temozolomide,TMZ)常规方案对MGMT阳性胶质瘤的化疗效果不理想.本实验在动物体内观察干扰素α/β(interfero...     

miR-370调控MGMT增强替莫唑胺对胶质瘤细胞化疗敏感性的实验研究

目的 探讨microRNA-370(miR-370)通过调控O6-甲基鸟嘌呤-DNA甲基转移酶(MGMT)增强替莫唑胺(TMZ)对胶质瘤化疗敏感性的机制研究.方法 采用TMZ浓度梯度递增法体外建立U87/TMZR耐药细胞株,分别转染阴性空质粒和miR-370 mimics作为miR-NC组和miR-370 mimics...     

DNA甲基化对miR-133a表达及胶质瘤细胞增殖及凋亡的影响

目的:探讨miR-133a在胶质瘤细胞中的表达及DNA甲基化对其的调控机制并初步探究miR-133a对胶质瘤细胞增殖及凋亡的影响。方法:通过RT-PCR检测胶质瘤组织与正常对照脑组织中miR-133a的表达差异;MSP实验检测胶质瘤组织与正常对照脑组织中miR-133a基因甲基化程度;BSP实验检测正常胶质细胞株HEB与胶质瘤细胞株A172、U87、U251中miR-133a基因的甲基化水平;去甲基化试剂AZA与胶质瘤细胞株A172、U87、U251共培养72 h后,RT-PCR检测上述3株胶质瘤细胞中的miR-133a表达变化;MTT及Annexin V-FITC凋亡实验分别检测AZA处理后的3株胶质瘤细胞的增殖与凋亡能力变化。结果:RT-PCR实验表明与正常对照脑组织相比,胶质瘤组织中miR-133a表达显著下降;MSP实验结果显示,与正常对照脑组织相比,胶质瘤组织中miR-133a基因的甲基化水平明显增高;BSP实验结果显示与正常对照胶质细胞株HEB相比,胶质瘤细胞A172、U87、U251中miR-133a基因的甲基化水平显著增加;RT-PCR实验显示与去甲基化试剂AZA共培养72 h后,胶质瘤细胞株A172、U87、U251细胞中miR-133a的表达显著增加。MTT与Annexin V-FITC凋亡实验结果表明,去甲基化试剂AZA处理后,胶质瘤细胞A172、U87、U251的增殖能力明显下降,细胞的凋亡发生率显著增加。结论:胶质瘤细胞中DNA甲基化通过调控miR-133a的表达而沉默后者发挥抑制肿瘤细胞增殖,促进肿瘤细胞凋亡的功能。     

5-Aza-CdR对人脑胶质瘤细胞miR-129-2表达水平及其生物学行为的影响

目的:探讨DNA甲基转移酶抑制剂5-氮杂-2'-脱氧胞苷（5-Aza-CdR）对人脑胶质瘤细胞U87和U373中miR-129-2表达水平及细胞增殖、侵袭迁移能力的影响。方法:以0.5 mmol/L的5-Aza-CdR处理人脑胶质瘤细胞U87和U373 72 h,采用RT-PCR法检测miR-129-2的表达水平,CCK-8法观察胶质瘤细胞增殖能力,Transwell试验检测细胞的侵袭能力,划痕实验检测细胞的迁移能力。结果:经5-Aza-CdR处理后人脑胶质瘤细胞U87和U373的miR-129-2表达水平显著上调,细胞增殖能力、侵袭迁移能力受到抑制。结论:5-Aza-CdR能使miR-129-2启动子去甲基化,使其表达上调,并能抑制胶质瘤细胞增殖、侵袭迁移能力。     

Delayed initiation of radiotherapy for glioblastoma: how important is it to push to the front (or the back) of the line?

The most effective chemotherapeutic for glioblastoma (GBM) is the DNA alkylating agent temozolomide (TMZ). In a recent study by Hegi et al. benefit from TMZ was significantly associated with methylation of the promoter of the O6-methylguanine-DNA methyltransferase (MGMT) gene; however, the correlation was imperfect. Some patients with methylated tumors were short survivors and others with unmethylated tumors were long survivors. These exceptions have raised the possibility that TMZ response might be influenced by non-MGMT mechanisms. The effect of p53 status on response to TMZ was explored in traditional glioma cell lines (U87MG, U251MG, U343MG, U373MG, SF767, LN443 and LNZ308) and brain tumor initiating cells (BTICs—BT012, BT025, BT042, BT048, BT060 and BT069) in two ways: (1) inhibition of p53 by RNAi and (2) sensitivity in relation to intrinsic p53 status, either wild-type or mutant. Traditional glioma cell lines that did not express a functional p53 were significantly more sensitive to TMZ than cell lines with functionally intact wild-type p53 expression. Altered p53 expression or function had only minor effects on TMZ sensitivity in BTICs and tended to decrease sensitivity to TMZ. RNAi specific for p53 had little effect on sensitivity in p53 null glioma cells. Absence of a functional p53 increases TMZ sensitivity in traditional glioma cell lines, an effect that is independent of MGMT status, and not seen in BTICs. P53 status may influence response to TMZ in differentiated cells in a GBM with a negligible affect on its initiating cells.     

MGMT modulates glioblastoma angiogenesis and response to the tyrosine kinase inhibitor sunitinib

Angiogenesis inhibitors, such as sunitinib, represent a promising strategy to improve glioblastoma (GBM) tumor response. In this study, we used the O⁶-methylguanine methyltransferase (MGMT)-negative GBM cell line U87MG stably transfected with MGMT (U87/MGMT) to assess whether MGMT expression affects the response to sunitinib. We showed that the addition of sunitinib to standard therapy (temozolomide [TMZ] and radiation therapy [RT]) significantly improved the response of MGMT-positive but not of MGMT-negative cells. Gene expression profiling revealed alterations in the angiogenic profile, as well as differential expression of several receptor tyrosine kinases targeted by sunitinib. MGMT-positive cells displayed higher levels of vascular endothelial growth factor receptor 1 (VEGFR-1) compared with U87/EV cells, whereas they displayed decreased levels of VEGFR-2. Depleting MGMT using O⁶-benzylguanine suggested that the expression of these receptors was directly related to the MGMT status. Also, we showed that MGMT expression was associated with a dramatic increase in the soluble VEGFR-1/VEGFA ratio, thereby suggesting a decrease in bioactive VEGFA and a shift towards an antiangiogenic profile. The reduced angiogenic potential of MGMT-positive cells is supported by: (i) the decreased ability of their secreted factors to induce endothelial tube formation in vitro and (ii) their low tumorigenicity in vivo compared with the MGMT-negative cells. Our study is the first to show a direct link between MGMT expression and decreased angiogenicity and tumorigenicity of GBM cells and suggests the combination of sunitinib and standard therapy as an alternative strategy for GBM patients with MGMT-positive tumors.     

长周期替莫唑胺治疗脑胶质瘤:附32例报告

背景与目的 :替莫唑胺(temozolomide,TMZ)国内外多推荐为胶质瘤的一线化疗药物,化疗周期通常为六周期。长周期(超过六周期)TMZ治疗胶质瘤国外已有多篇文献报道,但中国脑胶质瘤患者这方面信息较少。本文总结我们近年来长周期TMZ治疗32例胶质瘤的临床经验,重点探讨其安全性。方法:32例高级别胶质瘤(high-grade gliomas,HGGs)或低级别胶质瘤(low-grade gliomas,LGGs)采用了TMZ长周期治疗。TMZ化疗方案的选择基于肿瘤组织DNA甲基转移酶(O6-methylguanine-DNA methyltransferase,MGMT)的免疫组化检测结果,用甲基化特异PCR(MSP-PCR)检测了其中6例的MGMT启动子甲基化程度。MGMT阴性表达(±或-)者接受TMZ标准化疗(200mg/(m2.d),d1-5,四周方案),MGMT阳性表达(+或++)者接受TMZ剂量密度方案[75mg/(m2.d),d1-21,4周方案],或顺铂(cisplatin,DDP)联合TMZ化疗方案[DDP 75mg/(m2.d),d1-2;TMZ 200mg/(m2.d),d2-6,四周方案]。结果:32例患者共接受318周期TMZ方案化疗。患者化疗周期数为7~24(中位周期数为9.4)。最常见的严重毒性反应是Ⅲ度淋巴细胞减少症与白细胞减少症,发生率均为9.4%(3/32)。最常见的轻至中度毒性反应依次为疲乏(86.9%)、中性粒细胞减少症(46.9%)、脱发(46.9%)、血小板减少症(40.6%)、便秘(41.2%)及淋巴细胞减少症(25.0%)等。中位无进展生存(progress free survival,PFS)为28.6月。6月PFS、12月PFS分别为100%与71%。32例患者中,15例肿瘤完全切除,至今无病生存。依据意向性治疗原则(intention-to-treatprinciple,ITT),1例(3.1%)取得完全缓解(complete response,CR),14例(43.8%)微效(minor response,MR),2例(6.2%)稳定(stable disease,SD)。总反应率(overall response rate,ORR)为81.5%(95%CI,50%~96%),疾病控制率(disease control rate,DCR)为89.2%(95%CI,64%~98%)。结论:长周期TMZ化疗治疗胶质瘤是安全的。长周期TMZ化疗具有较高的反应率(ORR)与无进展生存(PFS)。     

ATM inhibitor KU-55933 increases the TMZ responsiveness of only inherently TMZ sensitive GBM cells

Ataxia telangiectasia mutated (ATM) kinase is critical in sensing and repairing DNA double-stranded breaks (DSBs) such as those induced by temozolomide (TMZ). ATM deficiency increases TMZ sensitivity, which suggests that ATM inhibitors may be effective TMZ sensitizing agents. In this study, the TMZ sensitizing effects of 2 ATM specific inhibitors were studied in established and xenograft-derived glioblastoma (GBM) lines that are inherently sensitive to TMZ and derivative TMZ-resistant lines. In parental U251 and U87 glioma lines, the addition of KU-55933 to TMZ significantly increased cell killing compared to TMZ alone [U251 survival: 0.004?±?0.0015 vs. 0.08?±?0.01 (p?<?0.001), respectively, and U87 survival: 0.02?±?0.005 vs. 0.04?±?0.002 (p?<?0.001), respectively] and also elevated the fraction of cells arrested in G2/M [U251 G2/M fraction: 61.8?±?1.1?% vs. 35?±?0.8?% (p?<?0.001), respectively, and U87 G2/M fraction 25?±?0.2?% vs.18.6?±?0.4?% (p?<?0.001), respectively]. In contrast, KU-55933 did not sensitize the resistant lines to TMZ, and neither TMZ alone or combined with KU-55933 induced a G2/M arrest. While KU-55933 did not enhance TMZ induced Chk1/Chk2 activation, it increased TMZ-induced residual ??-H2AX foci in the parental cells but not in the TMZ resistant cells. Similar sensitization was observed with either KU-55933 or CP-466722 combined with TMZ in GBM12 xenograft line but not in GBM12TMZ, which is resistant to TMZ due to MGMT overexpression. These findings are consistent with a model where ATM inhibition suppresses the repair of TMZ-induced DSBs in inherently TMZ-sensitive tumor lines, which suggests an ATM inhibitor potentially could be deployed with an improvement in the therapeutic window when combined with TMZ.     

中频交变微电流联合替莫唑胺对U251细胞的影响

目的:研究中频交变微电流(ACIF)联合替莫唑胺(TMZ)对胶质瘤U251细胞的作用。方法:将对数生长期的U251细胞分别暴露于ACIF组、TMZ组、联合组（ACIF+TMZ）作用下,采用CCK-8法检测细胞存活率,并运用流式细胞技术分析各组细胞的凋亡/死亡和细胞周期状态。结果:本实验将ACIF（50 kHz,150 mA,30 min）作用U251细胞后,细胞存活率为(86.49±0.23)% (P＜0.01),联合TMZ（IC50）干预后,细胞存活率为（33.28±1.67）%(P＜0.01);ACIF联合TMZ能够增加细胞凋亡率,阻滞细胞于G2/M期。结论:ACIF对U251细胞的增殖有一定的抑制作用,与TMZ联合应用时能表现出协同抗肿瘤作用。     

不同化疗药物对胶质瘤获得性SLC22A18基因耐药的逆转作用

目的:探讨临床上治疗胶质瘤的不同化疗药物对胶质瘤U251细胞获得性SLC22A18耐药的逆转作用及可能的分子机制。方法:将重组腺病毒载体(Ad)介导的SLC22A18基因联合替莫唑胺(TMZ)、卡氮芥(BCNU)以及顺铂(DDP)3种常见化疗药物处理对Ad/SLC22A18产生耐药的U251-SLC22A18/R胶质瘤细胞,通过MTT比色法检测处理后胶质瘤细胞的存活率,以评估体外不同化疗药物对SLC22A18耐药的逆转作用;在体内进一步评估该逆转策略的有效性;并且通过免疫印迹等方法探讨逆转耐药的可能的分子机制。结果:在体外只有TMZ和BCNU能够使U251-SLC22A18/R细胞对Ad/SLC22A18重新敏感。进一步的研究结果表明联合TMZ和Ad/SLC22A18能在体内有效地抑制U251-SLC22A18/R细胞来源的胶质瘤生长,且联合TMZ和Ad/SLC22A18抑制作用明显比其它对照组强。Ad/SLC22A18和TMZ的联合治疗可以下调MGMT蛋白的表达,并且Ad/SLC22A18和BCNU的联合治疗可以上调Bax蛋白的表达。结论:联合应用Ad/SLC22A18和TMZ或BCNU能在体内外有效地逆转U251-SLC22A18/R细胞对SLC22A18的获得性耐药,TMZ的逆转作用可能与其诱导的MGMT蛋白低表达有关,BCNU的逆转作用可能与其诱导的Bax蛋白过度表达有关。     

贝伐单抗联合化疗治疗复发性恶性胶质瘤:附12例经验

背景与目的 :美国综合癌症网(National Comprehensive Cancer Net,NCCN)治疗指南推荐贝伐单抗联合化疗治疗复发性恶性胶质瘤。但截至目前,中国脑胶质瘤患者这方面的报道较少。本文总结我们应用贝伐单抗联合化疗治疗12例复发性恶性胶质瘤的临床经验,探讨安全性与疗效。方法:12例复发性恶性胶质瘤均行贝伐单抗联合化疗。贝伐单抗5mg/kg,每两周一次。TMZ化疗方案的选择基于肿瘤组织DNA甲基转移酶(O6-methylguanine-DNA methyltransferase,MGMT)的免疫组化检测结果,行甲基化特异PCR(MSP-PCR)检测MGMT启动子甲基化程度。MGMT阴性表达(-)者,接受TMZ标准化疗[200 mg(/m2.d),d1-5,四周方案];MGMT阳性表达(+)者,或者MGMT阴性表达(-)者既往已接受标准剂量TMZ治疗但病情进展者,接受TMZ剂量密度方案[75mg(/m2.d),d1-21,四周方案]。结果:12例患者共接受63次贝伐单抗治疗,中位4次(3-10次)。12例患者均可评价客观疗效,完全缓解(complete remission,CR)2例(16.7%),部分缓解(partial remission,PR)2例(16.7%),微效(minimal remission,MR)8例(66.7%),疾病控制率(CR+PR+MR)为100%。中位无进展生存(progression freesurvival,PFS)为4.3个月(95%CI:2.4~7.3),6个月的PFS率为40.6%。最严重不良反应是Ⅲ度粒细胞减少症与白细胞减少症,各1例次(1.6%)。最常见的轻至中度不良反应包括Ⅱ度的腹泻8例次(12.7%)、Ⅱ度疲乏5例次(7.9%)、高血压2例次(3.2%)。结论:贝伐单抗联合化疗治疗国人复发恶性胶质瘤是安全的,疗效也令人满意。