Chemotherapy and biological therapy for meningiomas

The vast majority of meningiomas are benign neoplasms potentially curable with complete surgical resection. Radiotherapy is typically the adjuvant therapy of choice, once surgical options have been depleted, for recurrent or residual meningiomas requiring further therapy. Unfortunately, some meningiomas, not only atypical and malignant tumors but also benign tumors, recur despite maximal therapy with surgery and radiation. Thus, another effective form of adjuvant therapy is required in a small proportion of meningiomas. The most common chemotherapeutic agents in clinical practice are hormonal antagonists, targeting receptors known to be expressed by meningiomas, such as mifepristone, tamoxifen, medroxyprogesterone acetate (MPA), and pegvisomant. More recent evidence has suggested that hydroxyurea and interferon-α may be more effective therapy than hormonal antagonists for benign meningiomas. In contrast, malignant meningiomas are treated more like sarcomas with standard chemotherapeutic agents such as ifosfamide, doxorubicin, cisplatin, and dacarbazine. This article reviews the chemo- and biotherapeutic options available in the adjuvant therapy of meningiomas.