Advances in Targeted Therapies for Pediatric Brain Tumors
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Neuro-oncology (R Soffietti, Section Editor)
Advances in Targeted Therapies for Pediatric Brain Tumors Timothy Mueller, MD1 Ana Sofia Guerreiro Stucklin, MD, PhD1 Andreas Postlmayr, PhD1 Sarah Metzger, MD1 Nicolas Gerber, MD1 Cassie Kline, MD, MAS2 Michael Grotzer, MD1 Javad Nazarian, PhD1,3 Sabine Mueller, MD, PhD, MAS1,4,* Address *,1 Department of Oncology and Children’s Research Center, University Children’s Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland Email: [email protected] 2 Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA 3 Children’s National Health System, Center for Genetic Medicine Research, Washington, DC, USA 4 Department of Neurology, Neurosurgery and Pediatrics, University of California San Francisco, San Francisco, CA, USA
* The Author(s) 2020. This article is an open access publication
This article is part of the Topical Collection on Neuro-oncology Keywords Targeted therapy I Pediatric I Neuro-oncology I Glioma I Medulloblastoma I Craniopharyngioma
Abstract Purpose of Review Over the last years, our understanding of the molecular biology of pediatric brain tumors has vastly improved. This has led to more narrowly defined subgroups of these tumors and has created new potential targets for molecularly driven therapies. This review presents an overview of the latest advances and challenges of implementing targeted therapies into the clinical management of pediatric brain tumors, with a focus on gliomas, craniopharyngiomas, and medulloblastomas. Recent Findings Pediatric low-grade gliomas (pLGG) show generally a low mutational burden with the mitogen-activated protein kinase (MAPK) signaling presenting a key driver for these tumors. Direct inhibition of this pathway through BRAF and/or MEK inhibitors has proven to be a clinically relevant strategy. More recently, MEK and IL-6
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Curr Treat Options Neurol
(2020) 22:43
receptor inhibitors have started to be evaluated in the treatment for craniopharyngiomas. Aside these low-grade tumors, pediatric high-grade gliomas (pHGG) and medulloblastomas exhibit substantially greater molecular heterogeneity with various and sometimes unknown tumor driver alterations. The clinical benefit of different targeted therapy approaches to interfere with altered signaling pathways and restore epigenetic dysregulation is undergoing active clinical testing. For these multiple pathway-driven tumors, combination strategies will most likely be required to achieve clinical benefit. Summary The field of pediatric neuro-oncology made tremendous progress with regard to improved diagnosis setting the stage for precision medicine approaches over the last decades. The potential of targeted therapies has been clearly demonstrated for a subset of pediatric brain tumors. However, despite clear response rates, questions of sufficient blood-brain barrier penetration, optimal dosing, treatment duration as well as mechanisms of resistance and how these can be overcome with potential combination strate
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