Exciting New Advances in Neuro-Oncology: The Avenue to a Cure for Malignant Glioma§

Authors

  • Erwin G. Van Meir PhD,

    Corresponding author
    1. Professor, Department of Neurosurgery, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, Winship Cancer Institute, Emory University, Atlanta, GA
    • Department of Neurosurgery, Emory University School of Medicine, 1365C Clifton Road, NE, Atlanta, GA 30322
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  • Costas G. Hadjipanayis MD, PhD,

    1. Assistant Professor of Neurosurgery, Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, Winship Cancer Institute, Emory University, Atlanta, GA
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  • Andrew D. Norden MD, MPH,

    1. Instructor of Neurology, Center for Neuro-Oncology, Dana Farber/Brigham and Women's Cancer Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA
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  • Hui-Kuo Shu MD,

    1. Associate Professor of Radiation Oncology, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, Winship Cancer Institute, Emory University, Atlanta, GA
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  • Patrick Y. Wen MD,

    1. Professor of Neurology, Center for Neuro-Oncology, Dana Farber/Brigham and Women's Cancer Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA
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  • Jeffrey J. Olson MD

    Corresponding author
    1. Professor of Neurosurgery, Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, Winship Cancer Institute, Emory University, Atlanta, GA
    • Department of Neurosurgery, Emory University School of Medicine, 1365C Clifton Road, NE, Atlanta, GA 30322
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  • DISCLOSURES: Supported by National Institutes of Health (NIH) grants CA86335 and CA116804, the Goldhirsh Foundation, the Brain Tumor Funders Collaborative, the Southeastern Brain Tumor Foundation (to E.G.V.M.), NIH NS053454, the American Brain Tumor Association, the Southeastern Brain Tumor Foundation, the Georgia Cancer Coalition Distinguished Cancer Clinicians and Scientists Program, and the Dana Foundation (to C.G.H.). Dr. Norden has received honoraria from Genentech for serving on the advisory board and from Schering-Plough for serving on the speaker's bureau. Dr. Wen has received research support from Amgen, Genentech, Exelixis, Schering, Novartis, AstraZeneca, Boehringer, and Merck. The authors report no other conflicts of interest.

  • Available online at http://cajournal.org and http://cacancerjournal.org

  • §

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Abstract

Malignant gliomas are the most common and deadly brain tumors. Nevertheless, survival for patients with glioblastoma, the most aggressive glioma, although individually variable, has improved from an average of 10 months to 14 months after diagnosis in the last 5 years due to improvements in the standard of care. Radiotherapy has been of key importance to the treatment of these lesions for decades, and the ability to focus the beam and tailor it to the irregular contours of brain tumors and minimize the dose to nearby critical structures with intensity-modulated or image-guided techniques has improved greatly. Temozolomide, an alkylating agent with simple oral administration and a favorable toxicity profile, is used in conjunction with and after radiotherapy. Newer surgical techniques, such as fluorescence-guided resection and neuroendoscopic approaches, have become important in the management of malignant gliomas. Furthermore, new discoveries are being made in basic and translational research, which are likely to improve this situation further in the next 10 years. These include agents that block 1 or more of the disordered tumor proliferation signaling pathways, and that overcome resistance to already existing treatments. Targeted therapies such as antiangiogenic therapy with antivascular endothelial growth factor antibodies (bevacizumab) are finding their way into clinical practice. Large-scale research efforts are ongoing to provide a comprehensive understanding of all the genetic alterations and gene expression changes underlying glioma formation. These have already refined the classification of glioblastoma into 4 distinct molecular entities that may lead to different treatment regimens. The role of cancer stem-like cells is another area of active investigation. There is definite hope that by 2020, new cocktails of drugs will be available to target the key molecular pathways involved in gliomas and reduce their mortality and morbidity, a positive development for patients, their families, and medical professionals alike. CA Cancer J Clin 2010;60:166–193. © 2010 American Cancer Society, Inc.

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