Drug Therapy for Recurrent, Progressive, Atypical, and Malignant Meningiomas

European Association of NeuroOncology Magazine 2013; 3 (3): 128-131

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Keywords: meningioma,  neuro-oncology,  Statin,  tyrosine kinase inhibitor

So far, no breakthrough for systemic therapy of recurrent meningiomas has been achieved. Despite a multitude of optional drugs there is so far no standard of care. On the other hand, although the disease is rare, each neurooncological centre is faced with some patients with unmet treatment needs. Future attempts of drug therapy in meningiomas should be planned for the distinct subgroups of these heterogeneous tumours. Cohort studies should be able to answer the question of whether meningiomas occur more rarely or do not become symptomatic in individuals under treatment with statins, glitazones, or calcium channel blockers. If found effective, such drugs would be suitable as first-line treatment in patients with grade-I recurrent meningiomas, as for these indications most probably long treatment periods appear necessary. For patients whose tumours recur with such drugs, oral mTor antagonists such as everolimus or targeted therapies could potentially represent further treatment options which should be evaluated in multicentre phase-II studies, whereas cytotoxic drugs with severe side effects such as trabectedin could perhaps be investigated for recurrent malignant meningiomas after all other options have been exhausted.