Chemotherapy for malignant gliomas

Malignant gliomas are rare but lethal tumors in which the mainstays of therapy remain surgery and radiation therapy. Chemotherapy currently plays a primarily adjuvant role in the management of these patients with, unfortunately, little success in the recurrent disease setting. Barriers to efficacy of standard cytotoxic agents are related to drug-delivery challenges and inherent chemoresistance. Newer agents designed as directed antiglioma therapy are being explored with exciting preliminary results. Bevacizumab and other antiangiogenic drugs are likely to play a key role in the treatment of malignant glioma, as are combinations of molecularly targeted compounds. A greater understanding of cancer biology has afforded an increasing number and variety of oncogenic targets for therapeutic development, providing hope for brain tumor patients with historically poor outcomes.