In 2021, the World Health Organization released the fifth edition of the central nervous system (CNS) tumor classification. This classification uses histopathology and molecular pathogenesis to group tumors into more biologically and molecularly defined entities. The prognosis of brain cancer, particularly malignant tumors, has remained poor worldwide, approximately 308,102 new cases of brain and other CNS tumors were diagnosed in the year 2020, with an estimated 251,329 deaths. The cost and time-consuming nature of studies to find new anticancer agents makes it necessary to have well-designed studies. In the present study, the pathways that can be targeted for drug development are discussed in detail. Some of the important cellular origins, signaling, and pathways involved in the efficacy of bioactive molecules against CNS tumorigenesis or progression, as well as prognosis and common approaches for treatment of different types of brain tumors, are reviewed. Moreover, different study tools, including cell lines, in vitro, in vivo, and clinical trial challenges, are discussed. In addition, in this article, natural products as one of the most important sources for finding new chemotherapeutics were reviewed and over 700 reported molecules with efficacy against CNS cancer cells are gathered and Drug Dev Res. 2024;85:e22180. wileyonlinelibrary.com/journal/ddr Abbreviations: 4EBP1, eukaryotic initiation factor binding protein 1; AKT, protein kinase B; ATM, ataxia telangiectasia mutated; BBB, blood brain barrier; CAT, catalytic subunit; CDK, cyclin-dependent kinase; CDKs, cyclin-dependent kinases; CHOP, C/EBP HOMOLOGOUS PROTein; CK2, casein kinase 2; CNS, central nervous system; COX, cyclooxygenase; CSF, cerebrospinal fluid; cyt c, Cytochrome c; EC 50 , half maximal effective concentration; ED 50 , median effective dose, which is the dose that produces the effect in 50% of the population that take that dose; EGF, epidermal growth factor; EGFR, epidermal growth factor receptor; eIF4E, eukaryotic initiation factor 4E; ER, endoplasmic reticulum; ERK, extracellular-signal-regulated kinase; FGFR, fibroblast growth factor receptor; FPP, farnesyl pyrophosphate; FTase, farnesyltransferase; GB, glioblastoma; GBM, glioblastoma multiforme; GDP, guanosine diphosphate; GEFs, guanine nucleotide exchange factors; GFAP, glial fibrillary acidic protein; GGTase-I, geranylgeranyltransferase type I; GI50, concentration of any compound required for 50% growth inhibition of cells; Grb2, growth factor receptor-bound protein 2; GSK, glycogen synthase kinase; GTP, guanosine triphosphate; HAAE-2, human abdominal aorta endothelial cells; HDM2, human and/or murine double minute-2 protein; HIF-1α, hypoxia-inducible factor 1 alpha; HMGB1, high mobility group box 1 protein; IC 50 , half maximal inhibitory concentration; JNK, c-Jun N-terminal kinase; LOX, lipoxygenase; LPT, long-term potentiation; LRP, lipoprotein related proteins; LXRs, liver X receptors; mAB, monoclonal antibodies; MAPK, mitogen-activated protein kinase; MAPK, mitogen-activated protein kinase; MAST, microtubule-associated serine-threonine kinase; MDM2, p53-Mouse double minute 2; MEKis, MEK inhibitors; MMP, matrix metalloproteinase; mTORC1, mammalian target of rapamycin complex 1; MVA, mevalonate; MW, molecular weight; NAPA, Napabucasin; NF1, Neurofibromin 1; NIH, National Institutes of Health; NQO1, NAD(P)H Quinone Dehydrogenase 1; NSCs, neural stem cells; PA, pilocytic astrocytoma; PDGFR, platelet-derived growth factor receptor; PDGFRs, platelet-derived growth factor receptors; PERK, protein kinase RNA-like endoplasmic reticulum kinase (PERK); PFS, progression-free survival; PI3K, phosphatidylinositol-4,5-bisphosphate 3-kinase; PI3K, phosphatidylinositol-4,5-bisphosphate 3-kinase; PI3P, intracellular phosphatidylinositol-3,4,5-trisphosphate; PI(3,4,5)P3 or PIP3, phosphatidylinositol (3,4,5)-trisphosphate; PI(4,5)P2 or PIP2, phosphatidylinositol (4,5)-bisphosphate; pRB, retinoblastoma protein; PTEN, phosphatase and tensin homolog deleted on chromosome 10; PTM, posttranslational modification; RAGE, receptor for advanced glycation end products; RECK, reversion-inducing-cysteine-rich protein with kazal motifs; ROCK, RhoA-associated kinase; ROS, reactive oxygen species; RTKs, receptor tyrosine kinases; SAPKs, stress-activated protein kinases; SC, subcutaneous; Sp1, specificity protein 1; TAD, transactivation domain; TGI, concentration eliciting total growth inhibition; TKIs, tyrosine kinase inhibitors; TP53, tumor protein p53; TUNEL, terminal uridine deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling; VEGFRs, vascular endothelial growth factor receptors; WHO, World Health Organization. Ardalan Pasdaran and Azadeh Hamedi gathered data. All authors contributed in writing and revising the manuscript.