Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2026
Clinical outcomes of ferroptosis-inducing agents in glioblastoma: A systematic review of clinical trials.
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Choi Younseo, Hori Yusuke S, Abe Koki, Hosoda Ryusuke, Park David J, Kuno Atsushi, Chang Steven D
Аннотация
BACKGROUND: Glioblastoma (GBM) is the most aggressive type of primary central nervous system tumor with poor prognosis. Despite multimodal therapy, GBM remains clinically challenging, necessitating exploration of novel therapeutic strategies. Ferroptosis, an iron-dependent regulated cell death, has emerged as a potential approach to overcome resistance to conventional treatments. This review summarizes clinical evidence on ferroptosis-inducing agents in GBM.
METHODS: A systematic review was conducted using PubMed, Cochrane Library, and Web of Science. Clinical trials involving GBM or high-grade glioma patients treated with agents known to induce ferroptosis were included. Non-English articles, articles unavailable in full texts, preclinical studies, and other publication types were excluded.
RESULTS: Fourteen studies were included, with twelve evaluating sorafenib and one each evaluating sulfasalazine and lovastatin. Median sample size was 33.5 (range: 10-115), with median patient age ranging 50-60 years. In sorafenib trials, median progression-free survival (PFS) and overall survival (OS) ranged from 1.8 to 7.9 months and 4.4 to 18.0 months, respectively. A sulfasalazine trial reported a PFS of 1.1 months and OS of 2.3 months. Six-month PFS rates (PFS6) varied substantially (range: 0.0-86.7%). Improved outcomes were observed in studies with concomitant temozolomide or radiotherapy and in newly diagnosed populations. Grade ≥3 toxicities were reported in 32% to 65% of participants.
CONCLUSION: Ferroptosis-inducing agents demonstrate variable efficacy and safety in GBM, reflecting the heterogeneity of treatment regimens and patient populations. Clinical benefits, including efficacy and toxicity profiles, appear context-dependent, while the predominance of early-phase, nonrandomized study designs limits definitive conclusions. Further validation through standardized trial designs and improved drug delivery strategies will be essential to clarify the role of ferroptosis-inducing agents.
METHODS: A systematic review was conducted using PubMed, Cochrane Library, and Web of Science. Clinical trials involving GBM or high-grade glioma patients treated with agents known to induce ferroptosis were included. Non-English articles, articles unavailable in full texts, preclinical studies, and other publication types were excluded.
RESULTS: Fourteen studies were included, with twelve evaluating sorafenib and one each evaluating sulfasalazine and lovastatin. Median sample size was 33.5 (range: 10-115), with median patient age ranging 50-60 years. In sorafenib trials, median progression-free survival (PFS) and overall survival (OS) ranged from 1.8 to 7.9 months and 4.4 to 18.0 months, respectively. A sulfasalazine trial reported a PFS of 1.1 months and OS of 2.3 months. Six-month PFS rates (PFS6) varied substantially (range: 0.0-86.7%). Improved outcomes were observed in studies with concomitant temozolomide or radiotherapy and in newly diagnosed populations. Grade ≥3 toxicities were reported in 32% to 65% of participants.
CONCLUSION: Ferroptosis-inducing agents demonstrate variable efficacy and safety in GBM, reflecting the heterogeneity of treatment regimens and patient populations. Clinical benefits, including efficacy and toxicity profiles, appear context-dependent, while the predominance of early-phase, nonrandomized study designs limits definitive conclusions. Further validation through standardized trial designs and improved drug delivery strategies will be essential to clarify the role of ferroptosis-inducing agents.