New Developments in the Therapy for Glioma

The standard of care in adult glioblastoma is tumour resection followed by concomitant radio-/chemotherapy with temozolomide and 6 cycles of adjuvant temozolomide. To improve this standard, clinical trials are under way to evaluate efficacy and toxicity of cilengitide, an integrin antagonist, inhibitors of tyrosine kinases, of PKC-beta and of neo-angiogenesis and others. In the recurrent situation intensified chemotherapy regimens are applied and - with increasing frequency - the use of bevacizumab, an antibody to the vascular endothelial growth factor (VEGF). For recurrent glioblastoma the results with small molecules have been disappointing so far. For anaplastic glioma, WHO grade III, results of the NOA04-trial established a new standard in 2008. Regardless of an astrocytic or oligodendroglial origin, the results allow us to treat these grade III tumours postoperatively with chemotherapy alone as the first-line option. Low-grade glioma should be resected if complete tumour removal is achievable without new neurological symptoms. This guideline has gained support by 2 recent large retrospective analyses, showing a significantly better overall survival and progression-free survival in those patients whose tumour was (nearly) completely resected according to post-operative MRI measurements.