Molecular Biomarker-Based Chemotherapy and Targeted Therapy for Glioma

Gliomas encompass several histosubtypes, including pilocytic astrocytoma, astrocytoma, oligodendroglioma, and GBM. In recent years, numerous genomic studies of brain tumors have identified various genetic alterations and signaling pathways associated with glioma. Specifically, BRAF mutations/fusions in pilocytic astrocytomas, IDH1 mutations and 1p/19q co-deletions in oligodendrogliomas, and IDH mutations in gliomas with different prognosis have been identified. IDH mutations divide gliomas into two groups with distinct prognoses: the group with IDH mutation has a better prognosis, while the group with IDH wild type has a poor prognosis. LGG or GBM patients with IDH wild type often have EGFR amplification and PTEN deletion. Additionally, MGMT methylation is a predictive marker for the efficacy of TMZ chemotherapy in GBM patients. The TCGA study revealed that GBM can be classified into proneuronal, neuronal, classic, and mesenchymal subtypes based on mRNA expression and DNA methylation profiles. The inclusion of molecular pathology such as IDH and 1p/19q co-deletion in the WHO’s 2016 classification of CNS malignant tumors is a significant advance in the study of molecular pathology of gliomas. Nonetheless, the average survival of gliomas, particularly HGG, remains brief.