Abstract
Nowadays, due to recent advances in molecular biology, the pathogenesis of glioblastoma is better understood. For the newly diagnosed, the current standard of care is represented by resection followed by radiotherapy and temozolomide administration, but because median overall survival remains poor, new diagnosis and treatment strategies are needed. Due to the quick progression, even with aggressive multimodal treatment, glioblastoma remains almost incurable. It is known that epidermal growth factor receptor (EGFR) amplification is a characteristic of the classical subtype of glioma. However, targeted therapies against this type of receptor have not yet shown a clear clinical benefit. Many factors contribute to resistance, such as ineffective blood–brain barrier penetration, heterogeneity, mutations, as well as compensatory signaling pathways. A better understanding of the EGFR signaling network, and its interrelations with other pathways, are essential to clarify the mechanisms of resistance and create better therapeutic agents.
Highlights
With an overall survival of less than 35% in five years [1], malignant primary brain tumors are the most difficult to treat cancers
We present some of the most promising signaling pathways involved in pathogenesis, with their specific targeting components
It is well known that wild-type epidermal growth factor receptor (EGFR) ligands such as transforming growth factoralpha (TGF-alpha) and heparin-binding epithelial growth factor (EGF) (HB-EGF) are often increased in glioblastoma leading to an autocrine loop resulting in the autonomy growth of glioma cells [72]
Summary
With an overall survival of less than 35% in five years [1], malignant primary brain tumors are the most difficult to treat cancers. Because glioblastoma multiforme (GBM), a grade IV glioma [3], is one of the most aggressive primary brain tumors, recent studies and reviews have focused on deepening our understanding of the disease [4,5,6,7,8,9]. Receptor tyrosine kinases (RTKs) are activated by binding their extracellular domain to corresponding ligands determining their oligomerization This process activates the intracellular domain, facilitating the recruitment of proteins that start a signaling cascade, integrating numerous signaling pathways that lead to specific cellular responses [22]. A better understanding of the EGFR signaling network and its interrelations with other pathways are essential to improve drug activity, clarify the mechanisms of resistance, and develop better therapeutic agents
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