The Role of Systemic Therapies in the Treatment of Grades 1-4 Gliomas

The primary treatment for gliomas typically involves tumor resection followed by adjuvant radiotherapy, with increasing emphasis on chemotherapy and molecularly targeted drugs. This study aimed to review and summarize the literature on the systemic therapy of malignant gliomas. Chemotherapy may be considered in grades 2 and 3 gliomas, especially when mutations in 1p19q-codeletion are detected. The beneficial impact of adding chemotherapy to radiotherapy (PCV: procarbazine, lomustine, vincristine) has also been demonstrated. In grade 4 glioblastoma multiforme (GBM), wild-type isocitrate dehydrogenase (IDH) status showed the best treatment outcomes with temozolomide (TMZ) in patients with O-6-methylguanine-DNA methyltransferase (MGMT) promoter methylation. Prolonging adjuvant TMZ therapy improves treatment outcomes compared to the standard 6-cycle adjuvant therapy. Bevacizumab (BEV) monotherapy can improve progression-free survival and maintain the initial quality of life. Despite advancements in GBM treatment, outcomes remain unsatisfactory, with a median survival of 14-16 months. Further research is still needed regarding the systemic treatment of central nervous system gliomas.