Editorial: what is new in the treatment of gliomas?

PURPOSE OF REVIEW

In this editorial, we seek to critically analyse currently available options for the treatment of gliomas in order to provide guidance for evidence-based therapeutic decisions.

RECENT FINDINGS

Several recently reported trials in gliomas have investigated ways of optimizing traditional treatments (i.e. radiotherapy and cytotoxic chemotherapy), as well as novel approaches such as molecularly targeted therapy.

SUMMARY

Chemotherapy with temozolomide concomitant with radiotherapy remains a standard of care for glioblastoma, but current efforts are concentrated on confirming phase II results of protracted temozolomide schedules. The role of chemotherapy for grade III and II gliomas lacks phase III evidence but several trials are ongoing. Such trials are stratified by (or designed separately according to) chromosomes 1p/19q codeletion status, and such genetic analysis will thus be essential for therapeutic decisions in the future. The single positive results with targeted therapy remain to date the high response rates with bevacizumab and irinotecan in a phase II trial for recurrent malignant gliomas. Several questions regarding survival benefits and toxicity remain, however. Results of randomized trials of bevacizumab-based combinations are eagerly awaited, and if positive, they will point to antiangiogenesis strategies as the most promising current investigation venue in gliomas.