title: The challenges and the promise of molecular targeted therapy in malignant gliomas.
abstract: Malignant gliomas are the most common malignant primary brain tumors and one of the most challenging forms of cancers to treat. Despite advances in conventional treatment, the outcome for patients remains almost universally fatal. This poor prognosis is due to therapeutic resistance and tumor recurrence after surgical removal. However, over the past decade, molecular targeted therapy has held the promise of transforming the care of malignant glioma patients. Significant progress in understanding the molecular pathology of gliomagenesis and maintenance of the malignant phenotypes will open opportunities to rationally develop new molecular targeted therapy options. Recently, therapeutic strategies have focused on targeting pro-growth signaling mediated by receptor tyrosine kinase/RAS/phosphatidylinositol 3-kinase pathway, proangiogenic pathways, and several other vital intracellular signaling networks, such as proteasome and histone deacetylase. However, several factors such as cross-talk between the altered pathways, intratumoral molecular heterogeneity, and therapeutic resistance of glioma stem cells (GSCs) have limited the activity of single agents. Efforts are ongoing to study in depth the complex molecular biology of glioma, develop novel regimens targeting GSCs, and identify biomarkers to stratify patients with the individualized molecular targeted therapy. Here, we review the molecular alterations relevant to the pathology of malignant glioma, review current advances in clinical targeted trials, and discuss the challenges, controversies, and future directions of molecular targeted therapy.
authors: Department of Neurosurgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors: Hongxiang
authors: H
authors: Wang
authors: Department of Neurosurgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors: Tao
authors: T
authors: Xu
authors: Department of Neurosurgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors: Ying
authors: Y
authors: Jiang
authors: Department of Neurosurgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors: Hanchong
authors: H
authors: Xu
authors: Department of Neurosurgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors: Yong
authors: Y
authors: Yan
authors: Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China. Electronic address: fu800da900@126.com.
authors: Da
authors: D
authors: Fu
authors: Department of Neurosurgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China. Electronic address: juxiangchen.cz@gmail.com.
authors: Juxiang
authors: J
authors: Chen
mesh_terms: D000818:Animals; D000970:Antineoplastic Agents / Q000494:pharmacology / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000188:drug therapy*; D003131:Combined Modality Therapy; D005910:Glioma / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D058990:Molecular Targeted Therapy; D015398:Signal Transduction / Q000187:drug effects
chemical_list: D000970:Antineoplastic Agents