Pharmacotherapeutic options for atypical meningiomas

ABSTRACT

Introduction: Atypical meningiomas are aggressive tumors associated with high rates of recurrence and mortality. Current therapy is surgical resection followed by radiotherapy which has reasonable success rates. However, there are cases where surgical resection is not possible, and radiotherapy is not advisable.

Areas covered: In this short review, the authors have searched the current literature for explorations of adjuvant treatments such as chemotherapy and pharmaceutical agents. Most current chemotherapeutic agents have been unsuccessful in producing radiographic reduction or disease stabilization, although drugs like somatostatin analogs and plant-derived chemotherapeutics have shown some promise. The authors note that most of the studies in this field have been case series with a few randomized trials present. This makes it hard to ascertain the effectiveness of the drugs and so further research is required in the field.

Expert opinion: Finding pharmacotherapies to combat atypical meningiomas needs Big data genomic analysis. This will assist in generating drug candidates and a multidrug approach to therapy that will exploit several of the pathological pathways of atypical meningiomas. Using multidrug therapy that affects several pathways also addresses the issue of meningioma heterogeneity and adaptability.

KEYWORDS:

• Pharmacotherapy
• meningioma
• chemotherapy
• radiotherapy
• atypical meningioma
• unresectable meningioma
• pharmaceuticals
• genomic analysis

Article Highlights

• Atypical meningiomas or grade II WHO meningiomas are tumors with high rates of recurrence and associated complications.

• Currently, their management involves surgery followed by radiotherapy treatments. Although not all atypical meningiomas can be treated in such a fashion.

• New pharmacotherapies are being trialed to address the management of cases where surgery is not possible/feasible, and radiotherapy is not recommended.

• The somatostatin analog, octreotide, and some plant-derived chemotherapeutic agents have shown promise in phase II and III trials.

• No large-scale RCTs have been conducted on any of the pharmaceuticals.

• Big data analysis of genomic information, microRNA and study of various atypical meningioma pathways is crucial for generating new drug therapies. This would also help create individualized treatments for different atypical meningiomas.

• Multidrug regimens can then be trialed to address issues of tumor adaptability and heterogeneity.

This box summarizes key points contained in the article.

Declaration of interest

ME Sughrue receives a consulting fee for teaching educational courses for Medtronic and Synaptive. C Teo is a consultant for Aesculap. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.