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Background: Targeted therapies have substantially improved survival in cancer patients with malignancies outside the brain. Whether in-depth analysis for molecular alterations may also offer therapeutic avenues in primary brain tumors remains unclear. We herein present our institutional experience for glioma patients discussed in our interdisciplinary molecular tumor board (MTB) implemented at the Comprehensive Cancer Center Munich (LMU)., Methods: We retrospectively searched the database of the MTB for all recurrent glioma patients after previous therapy. Recommendations were based on next-generation sequencing results of individual patient's tumor tissue. Clinical and molecular information, previous therapy regimens, and outcome parameters were collected., Results: Overall, 73 consecutive recurrent glioma patients were identified. In the median, advanced molecular testing was initiated with the third tumor recurrence. The median turnaround time between initiation of molecular profiling and MTB case discussion was 48 ± 75 days (range: 32-536 days). Targetable mutations were found for 50 recurrent glioma patients (68.5%). IDH1 mutation (27/73; 37%), epidermal growth factor receptor amplification (19/73; 26%), and NF1 mutation (8/73; 11%) were the most detected alterations and a molecular-based treatment recommendation could be made for all of them. Therapeutic recommendations were implemented in 12 cases (24%) and one-third of these heavily pretreated patients experienced clinical benefit with at least disease stabilization., Conclusions: In-depth molecular analysis of tumor tissue may guide targeted therapy also in brain tumor patients and considerable antitumor effects might be observed in selected cases. However, future studies to corroborate our results are needed., Competing Interests: Jens Blobner No disclosures. Laura Dengler No disclosures. Constantin Eberle No disclosures. Sven Blobner No disclosures. Jonathan Weller No disclosures. Nico Teske No disclosures. Philipp Karschnia No disclosures. Katharina Rühlmann No disclosures. Kathrin Heinrich No disclosures. Frank Ziemann No disclosures. Philipp A GreifNo disclosures. Irmela Jeremias No disclosures. Rachel Wuerstlein No disclosures. Korbinian Hasselmann No disclosures. Mario Dorostkar No disclosures. Patrick N Harter No disclosures. Stefanie Quach No disclosures. Veit Stöcklein No disclosures. Nathalie Lisa Albert No disclosures. Maximilian Niyazi No disclosures. Joerg-Christian Tonn Research grants from Novocure and Munich Surgical Imaging, honoraria for lectures from BrainLab and CarThera and royalties from Springer Publisher Intl. Niklas Thon Speaker honoraria from Novocure and BrainLab. Benedikt Christoph Westphalen No disclosures. Louisa von Baumgarten No disclosures., (© The Author(s) 2023. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.)