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This combination therapy consists of the anti-angiogenic monoclonal antibody bevacizumab, the oral alkylating chemotherapy agent temozolomide, and the multi-target tyrosine kinase inhibitor (TKI) anlotinib. Bevacizumab works by binding to and neutralizing vascular endothelial growth factor A (VEGF-A), thereby inhibiting tumor angiogenesis. Temozolomide is a prodrug that delivers a methyl group to DNA, primarily at the O6 and N7 positions of guanine, leading to DNA damage and apoptosis in rapidly dividing tumor cells. Anlotinib further suppresses tumor growth and vascularization by inhibiting multiple receptor tyrosine kinases, including VEGFR1-3, FGFR1-4, PDGFRα/β, and c-Kit. This triple regimen is primarily investigated for the treatment of glioblastoma, particularly in recurrent or refractory cases, to overcome resistance to standard therapies. The Affiliated Cancer Hospital of Shandong First Medical University has been a key institution in evaluating this combination in clinical trials.
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