High-grade meningiomas: biology and implications

Area of Science:

• Neuro-oncology
• Genomics
• Immunology

Background:

• Meningiomas are traditionally treated with surgery and radiation.
• Genomic and immunological understanding of meningiomas is rapidly advancing.
• Targeted and immune therapies are novel treatment concepts for meningiomas.

Purpose of the Study:

• To review the evolving treatment landscape for meningiomas.
• To detail the genomic and immunological characteristics of different meningioma grades.
• To explore the implications of these findings for targeted and immune therapeutics.

Main Methods:

• Review of current literature on meningioma treatment modalities.
• Analysis of genomic alterations across different meningioma grades (I, II, III).
• Integration of genomic data with methylation profiles and immunological insights.

Main Results:

• Grade I meningiomas show diverse mutations (NF2, AKT1, SMO, etc.).
• Higher-grade meningiomas are primarily driven by NF2/chr22 loss with increased copy number alterations.
• Specific mutations (TERT, SMARCE1, BAP1) and PRC2 activation are linked to tumor progression and subtypes.
• Surgery remains crucial for recurrent high-grade tumors.

Conclusions:

• Genomic profiling is essential for understanding meningioma behavior and guiding treatment.
• Targeted and immune therapies hold promise, particularly for specific molecular subtypes.
• A multi-modal approach integrating surgery, radiation, and novel therapeutics is key for optimal meningioma management.