Medical management of high-grade astrocytoma: current and emerging therapies

High-grade astrocytomas are aggressive and incurable primary brain tumors. Radiation therapy with concurrent and adjuvant temozolomide chemotherapy is the standard-of-care treatment for newly diagnosed glioblastoma, while the role of chemotherapy in the initial treatment of anaplastic astrocytoma is evolving. Currently available medical options at tumor progression include further cytotoxic therapy and the vascular endothelial growth factor (VEGF) inhibitor bevacizumab. Investigational treatments including numerous molecularly targeted agents and immunotherapeutic approaches are currently being evaluated. Significant future progress will require better understanding and exploitation of the molecular heterogeneity within high-grade astrocytoma, as well as innovative trial designs to evaluate efficiently targeted therapies in the subsets of patients in which they are most likely to be effective.