Although, therapies directed to the vasculature of malignant gliomas are equally attractive in Europe and the United States of America (US), limited access to both trials and lack of approval by the European Medicines Agency (EMEA) prevented a de facto introduction into the current standard of care as seen in the US, where the compound is registered for recurrent glioblastoma since 05/2009. To date, the STEERING trial using the protein kinase C beta (PKC-.) inhibitor enzastaurin, the REGAL trial applying the vascular endothelial receptor inhibitor (VEGFR) cediranib, the PTK787/ZK trial and the upcoming dasatinib trial comprise the only structured European experience with such molecularly targeted drugs. Several national initiatives using bevacizumab (Avastin®) are now in place to fill the obvious gap. Despite the clear medical need for novel therapies for recurrent malignant glioma, neurooncology in Europe advocates randomized rather than uncontrolled trials to obtain additional data clarifying the role for bevacizumab in malignant gliomas.