Okezie O. Kanu¹, Betsy Hughes³, Chunhui Di³, Ningjing Lin², Jinrong Fu³, Darell D. Bigner^4,6, Hai Yan^4,6 and Cory Adamson^3,5,6,7

¹Lagos University Teaching Hospital, Lagos, Nigeria. ²Department of Oncology, Beijing Cancer Hospital, Peking University School of Oncology, Beijing, China. Departments of ³Surgery, ⁴Pathology and ⁵Neurobiology, Duke Medical Center, Durham, NC, U.S.A. ⁶Preston Robert Tisch Brain Tumor Center, Duke Medical Center, Durham, NC, U.S.A. ⁷Neurosurgery Section, Durham VA Medical Center, Durham, NC, U.S.A.

Abstract

In the adult population, glioblastoma multiforme is one of the most common primary brain tumors encountered. Unfortunately, this highly malignant tumor represents over 50% of all types of primary central nervous system gliomas. The vast majority of GBMs develops quite rapidly without clinical, radiological, or morphologic evidence of a less malignant precursor lesion (primary or de novo GBMs), as compared to secondary GBMs that develop slowly by progression from diffuse low-grade astrocytomas. These GBM subtypes must be kept in mind because they may constitute distinct disease entities. Even though they look histologically quite similar, they likely involve different genetic alterations and signaling pathways. Decades of surgical therapy, radiotherapy, and chemotherapy have failed to drastically change survival. Clearly, we do not fully understand this tumor; however, the exciting genetic revolution in glioma research over the past decade is providing a promising outlook for exploring this tumor at the genetic level. Science has begun to elucidate the numerous genetic alterations and critical signaling pathways, and it has opened new exciting areas of research such as glioma stem cell biology and neoangiogenesis. This work has already begun to improve our understanding of GBM cell proliferation, migration, and invasion. Indeed, exciting novel targeted therapies are making their way to clinical trials based on this increased knowledge. This review provides the current understanding of GBM oncogenomics, signaling pathways, and glioma stem cell biology and discusses the potential new therapeutic targets on the horizon.