Antiangiogenic treatment of meningiomas

Meningiomas are the most common intracranial tumors and the majority of cases is curable by surgical resection. Incompletely resected tumors and tumors with signs of increased malignancy (WHO grade II and III tumors) are prone to recur. In meningiomas relapsing after surgical resection and after exhaustion of radiotherapeutic options, drug therapy is to be considered. A variety of drugs has been studied in meningiomas, including hydroxyurea, temozolomide, irinotecan, interferon-alpha, mifepristone, octreotide analogues, megestrol acetate, bevacizumab, sunitinib, vatalinib, imatinib, erlotinib, and gefitinib. Unfortunately, most of these agents have shown no or very limited activity against meningiomas and cannot be recommended for clinical use. Compounds with antiangiogenic properties, i.e., bevacizumab, sunitinib, and vatalinib have shown potential efficacy in uncontrolled studies and should be investigated further, ideally in randomized clinical trials. Emerging clinical studies will evaluate novel medical treatment approaches including the tetra-hydroisoquinoline alkaloid trabectedin (European Organisation for Research and Treatment of Cancer (EORTC) phase II trial 1320) and SMO or AKT inhibitors in molecularly selected cases.