The Current Landscape of Neuro-Oncology Clinical Trials

CNS malignancies, particularly gliomas, are aggressive and often terminal brain tumors in adults. While advances have been made in the understanding of the glioma microenvironment and the molecular genetic pathways that drive gliomagenesis, translation into effective clinical therapies remains challenging. Barriers to therapeutic advancement include intrinsic factors such as the poorly understood blood-brain barrier, glioma heterogeneity, and the immunologically privileged environment of the brain. This review provides an exploration of therapeutic developments in neuro-oncology, namely - immunotherapies, targeted therapies, surgical trials and radiation therapy trials. We address the difficulty of glioma clinical trials designs and lessons from ineffective interventions. We discuss future strategies in improving breakthrough therapies for gliomas such as streamlining clinical trial design, integrating biomarkers and molecular targeting into studies, enhancing the validity and reproducibility of glioma trials.