Chemotherapy of Tumours of CNS

In spite of the fact that malignant gliomas have been considered resistant to chemotherapy and radiotherapy recently concomitant and adjuvant chemoradiotherapy with temozolomide (TMZ) has become standard treatment for newly diagnosed glioblastomas. MGMT promoter methylation status has been been shown to be important prognostic factor not only for predicting benefit from alkylating agents but also for predicting the survival. Extrapolation of these results obtained in glioblastomas to lower-grade gliomas appears premature. New data from clinical trial of sequential radio chemotherapy of anaplastic gliomas may allow recommending chemotherapy PCV or TMZ) as first line treatment of these tumours. IDH1 mutation emerged from this study as a novel prognostic marker as well as 1p/19q status or MGMT promoter methylation. Better understanding of the molecular mechanisms allows for the rational targeting and development specifically targeted therapies by clinical trials in conjunction with standard TMZ/RT therapy. An accelerated approval of bevacizumab in relapsed glioblastomas is discussed. (author)