Till date, no breakthrough for systemic therapy of recurrent meningiomas has been achieved. The multitude of optional drugs shows that none of them so far could become a standard of care. On the other hand, although the disease is rare, each neurooncological centre has some patients with unmet treatment needs. Cohort studies should be able to answer the question whether meningiomas occur more rarely or do not become symptomatic in individuals undergoing treatment with statins, glitazones, or calcium channel blockers. If found effective, such drugs would be suitable as first line treatment in patients with grade I recurrent meningiomas, because for these indications most probably the long treatment periods appear necessary. For patients who recur with such drugs, targeted therapies could represent further treatment options, whereas cytotoxic drugs with severe side effects such as trabectedin could perhaps be investigated for recurrent malignant meningiomas after all other options.