Treatment of high-grade gliomas in adults

Abstract

Surgery, radiation therapy, and chemotherapy with temozolomide are the mainstays of treatment for patients with high-grade gliomas. The addition of temozolomide leads to a significant improvement in 2-year survival compared to radiation alone, although 2-year survival remains less than 30%. Responsiveness to temozolomide depends on the activity of O6-methylguanine-DNA methyltransferase in tumor cells. Increasing evidence suggests that certain molecular pathways are selectively upregulated in tumor cells. Some of these pathways have been shown to be instrumental in proliferation, migration, invasion, angiogenesis, and survival in preclinical models and therefore represent attractive therapeutic targets. This chapter will summarize the current standard of care of the different treatment modalities and some of the novel therapies undergoing evaluation.