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Adaptable Angled Stereotactic Approach for Versatile Neuroscience Techniques
Published on: May 7, 2020
Innovating Strategies and Tailored Approaches in Neuro-Oncology
Alberto Picca1, David Guyon2, Orazio Santo Santonocito3
1Institut du Cerveau-Paris Brain Institute-ICM, Sorbonne Université, Inserm, CNRS, AP-HP, Hôpital Universitaire La Pitié Salpêtrière, DMU Neurosciences, 75013 Paris, France.
Abstract:
Diffuse gliomas, the most frequent and aggressive primary central nervous system neoplasms, currently lack effective curative treatments, particularly for cases lacking the favorable prognostic marker IDH mutation. Nonetheless, advances in molecular biology allowed to identify several druggable alterations in a subset of IDH wild-type gliomas, such as NTRK and FGFR-TACC fusions, and BRAF hotspot mutations. Multi-tyrosine kinase inhibitors, such as regorafenib, also showed efficacy in the setting of recurrent glioblastoma. IDH inhibitors are currently in the advanced phase of clinical evaluation for patients with IDH-mutant gliomas. Several immunotherapeutic approaches, such as tumor vaccines or checkpoint inhibitors, failed to improve patients' outcomes. Even so, they may be still beneficial in a subset of them. New methods, such as using pulsed ultrasound to disrupt the blood-brain barrier, gene therapy, and oncolytic virotherapy, are well tolerated and may be included in the therapeutic armamentarium soon.
Insights
Effective treatments for diffuse gliomas, especially IDH-wildtype, are limited. Research is exploring targeted therapies like NTRK fusions and novel approaches such as gene therapy for better outcomes.
Area of Science:
- Neuro-oncology
- Molecular Biology
- Genetics
Background:
- Diffuse gliomas are aggressive primary central nervous system neoplasms.
- Effective curative treatments are lacking, particularly for IDH-wildtype gliomas.
- Targetable molecular alterations are being identified in IDH-wildtype gliomas.
Purpose of the Study:
- To review current and emerging therapeutic strategies for diffuse gliomas.
- To highlight advancements in molecularly targeted therapies.
- To discuss novel treatment modalities.
Main Methods:
- Review of current literature on diffuse glioma treatments.
- Analysis of molecular alterations and their therapeutic implications.
- Evaluation of novel treatment approaches including gene therapy and virotherapy.
Main Results:
- Druggable alterations like NTRK fusions, FGFR-TACC fusions, and BRAF mutations identified in IDH-wildtype gliomas.
- Multi-tyrosine kinase inhibitors show efficacy in recurrent glioblastoma.
- IDH inhibitors are in clinical trials for IDH-mutant gliomas.
- Immunotherapy has shown limited success but may benefit subsets of patients.
- New methods like pulsed ultrasound, gene therapy, and oncolytic virotherapy are promising.
Conclusions:
- Targeted therapies and novel approaches offer new hope for diffuse glioma treatment.
- Personalized medicine based on molecular profiling is crucial.
- Emerging technologies may soon expand the therapeutic armamentarium for these challenging tumors.
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