Latest Treatments and Expectations for Precision Medicine against Malignant Glioma

Abstract

  Malignant glioma is one of the most intractable malignant neoplasms. Standard treatment consists of surgery, radiotherapy, and chemotherapy, although substantial therapeutic effects cannot be expected. In particular, the blood-brain barrier (BBB) protects the central nervous system, reducing the effectiveness of chemotherapy. Temozolomide is the standard treatment, but it only prolongs the median survival time by about two months compared to surgery and radiation. Molecular-targeted therapies, which have revolutionized the treatment of many cancer types, have all failed to treat malignant gliomas, and the focus is now on the spatial and temporal diversity of tumors. In addition, the problem of drug penetration across the BBB has been refocused. Precision medicine is also attracting great expectations, but panel testing can only be done once. Even if an expert panel recommends a treatment, there is a problem in that most treatments have to rely on investigational therapies. It is also known that even if there is a draggable genetic abnormality in tumors, drugs targeting those abnormalities are often ineffective against brain tumors. Therefore, it is necessary that all novel therapeutic approaches, such as virus therapy, neutron capture therapy, and drug delivery techniques like convection-enhanced delivery, be employed to improve treatment outcomes in malignant glioma.