Precision Neuro-oncology: A Comprehensive Review of Molecular Diagnostics and Therapies in Glioma Care

Abstract

Cancer is the uncontrolled proliferation of abnormal cells that invades adjacent tissues and metastasizes in the lymphatic or bloodstream. Central Nervous System (CNS) tumors, and most notably gliomas are formidable to treat because of their aggressiveness, molecular heterogeneity, and resistance to standard therapy. Gliomas are the most prevalent primary malignant brain tumors and have a poor prognosis due to the limited choices of treatment. The 2021 World Health Organization Classification of CNS Tumors (WHO CNS5) has transformed glioma diagnosis with the inclusion of certain molecular markers like isocitrate dehydrogenase (IDH) mutations, 1p/19q co-deletion, loss of Alpha Thalassemia/Mental Retardation Syndrome X-linked (ATRX), and Tumor Protein 53 (TP53) mutations, in addition to the classic histopathological features. Next generation sequencing (NGS) has also revolutionized neuro-oncology by enabling the specific detection of genetic alterations responsible for tumor formation. NGS makes it possible to detect mutations, amplifications, and gene fusions with increased specificity, opening the door to more personalized and possibly efficacious treatment. In India, the increasing rate of CNS tumors emphasizes the imperative need for better diagnosis and treatment infrastructure. This review summarizes international and Indian trends in cancer epidemiology, developments in glioma classification, current diagnostic challenges, and the emerging roles of targeted sequencing and treatments in CNS tumor precision medicine. These molecular advances enable precise risk stratification and many different targeted therapies like IDH inhibitors and MGMT, which can help the clinicians to integrate NGS with other gold standard diagnostic methods and provide precise treatment and enhance progression free survival.