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High-grade meningiomas: new avenues for drug treatment?
Matthias Preusser1, Anna S Berghoff, Andreas F Hottinger
1aDepartment of Medicine I & Comprehensive Cancer Center - CNS Unit, Medical University of Vienna bDepartment of Clinical Neurosciences, CHUV, Lausanne University Medical Center and University of Lausanne, Switzerland.
Purpose Of Review:
For standard first-line treatment of high-grade meningiomas, surgical resection and radiotherapy are regarded as standard of care. In the recurrent setting after exhaustion of all local treatment options, no effective therapies are known and several drugs have failed to show efficacy, but novel compounds may offer hope for better disease control.
Recent Findings:
Upregulation of proangiogenic molecules and dysregulation of some signaling pathways such as the platelet-derived growth factor and mammalian target of rapamycin are recurrently found in high-grade meningiomas. Furthermore, in-vitro studies and single patient experience indicate that trabectedin may be an effective therapy in this tumor type. Unfortunately, so far there is a lack of conclusive clinical trials to draw definite conclusions of efficacy of these approaches.
Summary:
There remains a significant unmet need for defining the role of medical therapy in recurrent high-grade meningioma, and more basic research and multicentric well designed trials are needed in this rare and devastating tumor type. Potentially promising novel therapeutics include antiangiogenic drugs, molecular inhibitors of signaling cascades, immunotherapeutics or trabectedin. However, more basic research is required to identify more promising drug targets.
Video Abstract Available:
See the Video Supplementary Digital Content 1 (http://links.lww.com/CONR/A22).
Insights
Recurrent high-grade meningiomas lack effective treatments. Novel therapies like trabectedin show promise, but more research and clinical trials are essential for better disease control.
Area of Science:
- Neuro-oncology
- Medical therapy research
- Cancer signaling pathways
Background:
- Standard treatment for high-grade meningiomas includes surgery and radiotherapy.
- Recurrent meningiomas, after local treatments are exhausted, have no established effective therapies.
- Novel therapeutic compounds offer potential for improved disease control.
Observation:
- Proangiogenic molecules are upregulated in high-grade meningiomas.
- Platelet-derived growth factor and mTOR signaling pathways are dysregulated.
- In vitro studies and case reports suggest trabectedin efficacy.
Findings:
- Current clinical trials are insufficient to confirm the efficacy of novel approaches.
- There is a significant unmet need for effective medical therapies in recurrent high-grade meningioma.
- Trabectedin, antiangiogenic drugs, and signaling inhibitors are potential therapeutics.
Implications:
- Further basic research is needed to identify optimal drug targets.
- Multicenter, well-designed clinical trials are crucial for evaluating new treatments.
- Developing effective medical therapies is critical for this rare and aggressive tumor type.
