title: High-grade meningiomas: new avenues for drug treatment?
abstract: OBJECTIVE
  For standard first-line treatment of high-grade meningiomas, surgical resection and radiotherapy are regarded as standard of care. In the recurrent setting after exhaustion of all local treatment options, no effective therapies are known and several drugs have failed to show efficacy, but novel compounds may offer hope for better disease control.
  
  
  RESULTS
  Upregulation of proangiogenic molecules and dysregulation of some signaling pathways such as the platelet-derived growth factor and mammalian target of rapamycin are recurrently found in high-grade meningiomas. Furthermore, in-vitro studies and single patient experience indicate that trabectedin may be an effective therapy in this tumor type. Unfortunately, so far there is a lack of conclusive clinical trials to draw definite conclusions of efficacy of these approaches.
  
  
  CONCLUSIONS
  There remains a significant unmet need for defining the role of medical therapy in recurrent high-grade meningioma, and more basic research and multicentric well designed trials are needed in this rare and devastating tumor type. Potentially promising novel therapeutics include antiangiogenic drugs, molecular inhibitors of signaling cascades, immunotherapeutics or trabectedin. However, more basic research is required to identify more promising drug targets.
  
  
  BACKGROUND
  See the Video Supplementary Digital Content 1 (http://links.lww.com/CONR/A22).
authors.affiliation: aDepartment of Medicine I & Comprehensive Cancer Center - CNS Unit, Medical University of Vienna bDepartment of Clinical Neurosciences, CHUV, Lausanne University Medical Center and University of Lausanne, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Preusser
authors.forename: Anna S
authors.initials: AS
authors.lastname: Berghoff
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Hottinger
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D049673:History, 20th Century; D006801:Humans; D008577:Meningeal Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000266:history; D008579:Meningioma / Q000188:drug therapy* / Q000235:genetics / Q000266:history; D015398:Signal Transduction / Q000187:drug effects
chemical_list: D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents