High-grade Gliomas

This article reviews the standard treatment for high-grade gliomas, with a focus on promising new strategies and response assessment.

The new World Health Organization (WHO) classification of central nervous system tumors classifies high-grade gliomas based on molecular markers that are of prognostic and therapeutic significance. The addition of chemotherapy, specifically procarbazine, CCNU (lomustine), and vincristine, to radiation in newly diagnosed 1p/19q codeleted anaplastic oligodendrogliomas doubled overall survival. The US Food and Drug Administration (FDA) recently approved the addition of tumor treating fields to adjuvant temozolomide after radiation with concurrent temozolomide in newly diagnosed glioblastoma. A phase3 trial for recurrent glioblastoma did not show an overall survival benefit for the addition of bevacizumab to lomustine compared to lomustine alone. Current efforts are focused on the development of novel treatment approaches, including molecular targeted agents and immunotherapies.

Surgery, radiation, and chemotherapy remain the standard treatment options for patients with high-grade gliomas. Despite aggressive treatment, these tumors progress, and overall outcomes have not changed much in the past decade. However, our understanding of the disease is improving, and newer therapies appear promising.