Current challenges in the treatment of gliomas: The molecular era

Abstract

Gliomas originate from glial cells in the central nervous system. Approximately 80%-85% of malignant brain tumors in adults are gliomas. The most common central nervous system tumor in children is low-grade pediatric glioma. Diagnosis was determined by histological features until 2016 when the World Health Organization classification integrated molecular data with anatomopathological information to achieve a more integral diagnosis. Molecular characterization has led to better diagnostic and prognostic staging, which in turn has increased the precision of treatment. Current efforts are focused on more effective therapies to prolong survival and improve the quality of life of adult and pediatric patients with glioma. However, improvements in survival have been modest. Currently, clinical guidelines, as well as the article by Mohamed et al accompanying this editorial piece, are adapting treatment recommendations (surgery, chemotherapy, and radiotherapy) according to diagnosis and prognosis guided by molecular biomarkers. Furthermore, this paves the way for the design of clinical trials with new therapies, which is especially important in pediatric gliomas.

Keywords: Gliomas; Chemotherapy; Radiotherapy; Isocitrate dehydrogenase-type mutant; Pediatric gliomas; Astrocytoma; Oligodendroglioma; 1p/19q-codeleted

Core Tip: The current trimodal approach including surgery, radiotherapy, and chemotherapy for the treatment of gliomas has benefited from the introduction of molecular diagnosis. However, new challenges have appeared. There is still debate on the best therapeutic option. In this editorial, we focused on the controversial areas in molecular classification and new treatment advances.