title: Standard of care and future pharmacological treatment options for malignant glioma: an urgent need for screening and identification of novel tumor-specific antigens.
abstract: BACKGROUND
  Malignant gliomas (MGs) represent the most common primary brain tumors in adults, the most deadly of which is grade IV glioblastoma. Patients with glioblastoma undergoing current standard-of-care therapy have a median survival of 12 - 15 months.
  
  
  METHODS
  Over the past 25 years, there have been modest advancements in the treatment of MGs. Assessment of therapeutic responses has continued to evolve to account for the increasing number of agents being tested in the clinic. Currently approved therapies for primary tumors have been extended for use in the setting of recurrent disease with modest efficacy. Agents initially approved for recurrent gliomas have begun to demonstrate efficacy against de novo tumors but will ultimately need to be evaluated in future studies for scheduling, timing and dosing relative to chemotherapy.
  
  
  CONCLUSIONS
  Screening and identification of tumor-specific mutations is critical for the advancement of effective therapy that is both safe and precise for the patient. Two unique antigens found in glioblastoma are currently being employed as targets for immunotherapeutic vaccines, one of which has advanced to Phase III testing. Whole genome sequencing of MGs has yielded two other novel mutations that offer great promise for the development of molecular inhibitors.
authors.affiliation: Duke University Medical Center, Duke Brain Tumor Immunotherapy Program, Division of Neurosurgery, Department of Surgery , DUMC Box 3050, 303 Research Drive, 220 Sands Building, Durham, NC 27710 , USA +1 919 684 9041 ; +1 919 684 9045 ; john.sampson@duke.edu.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Batich
authors.forename: John H
authors.initials: JH
authors.lastname: Sampson
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000951:Antigens, Neoplasm / Q000235:genetics / Q000378:metabolism*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000235:genetics / Q000378:metabolism; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism; D019496:Cancer Vaccines / Q000627:therapeutic use; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy; D005909:Glioblastoma / Q000188:drug therapy / Q000276:immunology / Q000378:metabolism; D005910:Glioma / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism; D006801:Humans; D009154:Mutation; D009364:Neoplasm Recurrence, Local; D059039:Standard of Care
chemical_list: D020533:Angiogenesis Inhibitors; D000951:Antigens, Neoplasm; D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D019496:Cancer Vaccines
keywords: EGFR variant III; antiangiogenic agents; glioblastoma; isocitrate dehydrogenase; malignant glioma; temozolomide; tumor-specific antigen