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Advances in Pharmacological Therapy for Recurrent High-Grade Meningiomas
Ruining Bai1, Shuo Yin1, Yali Wang1
1Department of Neuro-Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Introduction:
World Health Organization (WHO) grade 2 and 3 meningiomas are aggressive neoplasms characterized by high postoperative recurrence rates and unfavorable prognoses. Despite advances in surgical and radiotherapeutic management, effective systemic treatment options for recurrent WHO grade 2/3 meningiomas remain limited, with most therapies still under clinical investigation.
Objective:
To evaluate the efficacy and safety of various pharmacological treatment strategies for recurrent high-grade meningioma, including conventional chemotherapy, targeted therapy, and immunotherapy.
Methods:
A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and ClinicalTrials.gov from database inception to August 2025. Relevant studies investigating conventional chemotherapy, targeted therapy, and immunotherapy for recurrent high-grade meningioma were systematically reviewed to summarize current advances in precision therapeutic strategies.
Discussion:
Conventional cytotoxic chemotherapy has demonstrated limited survival benefit in recurrent high-grade meningioma and is primarily used for palliative symptom management. In contrast, molecular targeted therapies have shown varying degrees of anti-tumor activity, including anti-angiogenic agents, Tyrosine Kinase Inhibitors (TKI), Focal Adhesion Kinase (FAK) inhibitors, and Mammalian Target of Rapamycin (mTOR) inhibitors. Among these, Bevacizumab demonstrated relatively favorable efficacy, prolonging median progression-free survival to 12-18 months in phase II clinical studies. Immunotherapy has also emerged as a promising therapeutic approach. Programmed death-1 (PD-1) inhibitors achieved 6-month progression-free survival rates (PFS-6) of up to 48% in early clinical studies. Furthermore, emerging immunotherapeutic strategies, such as chimeric antigen receptor T-cell (CAR-T) therapy, oncolytic virus (OVs) therapy, and personalized tumor vaccines, have demonstrated preliminary therapeutic potential. Nevertheless, developing standardized treatment strategies remains challenging due to limited clinical trial sample sizes, methodological heterogeneity, and substantial intertumoral and intratumoral molecular variability.
Conclusion:
Future research should prioritize molecular subtype-based therapeutic strategies to facilitate personalized treatment according to tumor biology. In addition, combination regimens integrating targeted therapy and immunotherapy may further improve therapeutic response and quality of life in patients with recurrent high-grade meningioma.
Insights
Recurrent high-grade meningiomas have limited treatment options. Targeted therapies and immunotherapies show promise, with combination strategies potentially improving outcomes for this aggressive brain tumor.
Area of Science:
- Neuro-oncology
- Pharmacology
- Immunology
Background:
- World Health Organization (WHO) grade 2 and 3 meningiomas are aggressive brain tumors with high recurrence rates.
- Effective systemic treatments for recurrent high-grade meningiomas are limited, necessitating research into novel therapeutic strategies.
Purpose of the Study:
- To systematically review the efficacy and safety of pharmacological treatments for recurrent high-grade meningioma.
- To summarize advances in conventional chemotherapy, targeted therapy, and immunotherapy for this challenging condition.
Main Methods:
- A comprehensive literature search was performed across major databases (PubMed, Embase, Web of Science, ClinicalTrials.gov).
- Studies investigating pharmacological interventions for recurrent high-grade meningioma were systematically reviewed.
Main Results:
- Conventional chemotherapy offers limited survival benefits, primarily for symptom management.
- Molecular targeted therapies, including anti-angiogenic agents and TKIs, show anti-tumor activity. Bevacizumab demonstrated promising progression-free survival (12-18 months).
- Immunotherapies, such as PD-1 inhibitors (PFS-6 up to 48%), CAR-T, oncolytic viruses, and personalized vaccines, show preliminary therapeutic potential.
Conclusions:
- Targeted therapies and immunotherapies represent promising avenues for recurrent high-grade meningioma.
- Future research should focus on molecular subtype-based treatments and combination regimens for improved patient outcomes and quality of life.
