The role of chemotherapy and targeted therapy in the treatment of intracranial meningioma

Abstract

A number of challenges are apparent with respect to the use of chemotherapy or targeted therapy for intracranial meningioma. First, there is very limited published literature that provides compelling evidence from which to determine appropriate therapy. Second, there is a paucity of clinical trials for patients with recurrent meningioma. Third, there remains a lack of agreement or standardization as to what constitutes a meaningful response to medical therapy recognizing these metrics differ between low-grade and high-grade recurrent meningioma. As a consequence, there remains a significant unmet need in neuro-oncology for defining the role of chemotherapy or targeted therapy in recurrent meningioma.

Review of controversies in management of non-benign meningioma

“…It was shown to be efficacious against meningioma cell lines and against recurrent benign meningioma in vitro [79][80][81]82].…”

Peptide Receptor Targeting in Cancer: The Somatostatin Paradigm

“…The high incidence of SST receptors in human meningiomas is known since decades [219] and the inhibitory role of SST in the control of proliferation in primary cultures of human meningioma cells has been described [220]. The rationale for the use of SST analogs in the control of intracranial meningioma is supported by the widespread expression of SST receptors in this tumor and by the fact that currently no adjuvant therapy for meningioma is available in patients with unresectable or radioresistant lesions [221]. Limited clinical data are currently available about SST analogs in vivo , but SST antiangiogenic activity might be useful in refractory meningiomas as reported by The Central Nervous System National Comprehensive Cancer Network guidelines that suggests as treatment options hydroxyurea, interferon- α , or octreotide LAR [222].…”

A five year-old child with clear cell petro-clival meningioma: case report with clinical and histopathological long-term follow-up

“…Similarly, the overexpression of the PDGF-receptor has been associated with meningioma cell growth via an autocrine loop [14]. Furthermore, the VEGF receptor was reported to be overexpressed in meningioma, playing a central role in meningioma angiogenesis-which are highly vascular tumorsand in the formation of peritumoral edema [12]. The expression of all these receptors was observed to be more enhanced in atypical and malignant meningioma than in benign meningiomas.…”

“…Chemotherapy as a treatment option in this meningioma subtype has, however, not been investigated in prospective studies due to their low frequency. In general, there is most likely no place for chemotherapy or targeted therapy for meningiomas regardless of WHO grade, since several trials of chemotherapeutic agents did not reveal significant tumor control or regression [12]. This can be explained by the fact that meningiomas are heterogeneous tumors with distinct histopathological and cytogentic features.…”