In this interview we discuss updates, challenges, and contributing factors associated with pediatric brain cancers.
As part of Cancer Network’s coverage of the 21st Annual Scientific Meeting of the Society for Neuro-Oncology, held November 17–20 in Scottsdale, Arizona, we spoke with pediatric neuro-oncologist and Clinical Associate Professor Sonia Partap, MD, MS, Child Neurology & Neuro-Oncology, Stanford University & Lucile Packard Children’s Hospital, Palo Alto, California.
-Interviewed by Bryant Furlow
Cancer Network: You have been asked to speak about important advances in pediatric brain cancer at this year’s meeting. What will you spotlight?
Dr. Partap: I will highlight the new World Health Organization 2016 classifications in pediatric glioma and medulloblastoma which now have molecular definitions. This is a huge advancement that has standardized our field and can guide therapy and research.
I will also emphasize that craniospinal radiation after chemotherapy is standard care for children with central nervous system (CNS) nongerminomatous germ cell tumor.
Cancer Network: You and others have raised concerns about the impact of social and economic disparities on outcomes for children with brain cancer. Tell us about that.
Dr. Partap: Preliminary data suggests children with medulloblastoma and private insurance have a better outcome than those without private insurance. There is also data that children with high-grade glioma and a lower social economic status have a worse overall survival than others. Whether these differences are due to pitfalls in access to care (delay in diagnosis) and clinical trials (novel therapies) have yet to be determined.
Cancer Network: Does it appear that ethnicity per se is associated with pediatric brain tumor biology or treatment outcomes, in addition to socioeconomic disparities?
Dr. Partap: We know that Asians have a higher incidence of CNS germ cell tumors compared to other ethnicities. Other ethnic disparities in treatment outcomes need to be studied on a broader scale in pediatric neuro-oncology-ranging from the tumor biology itself to differences in chemotherapy metabolism and pharmacogenomics.
Cancer Network: What do we know about the causes of pediatric brain cancers?
Dr. Partap: The only known environmental risk factor is exposure to ionizing radiation. With advances in genomic analysis, we are finding many more affected children with cancer predisposition syndromes such as Li-Fraumeni (TP53) and other germline mutations that are likely causative of cancer. New discoveries and improvements in genetic testing will help us steer future therapies. Since pediatric brain cancers are rare, it is essential to collaborate with large cancer databases such as Surveillance, Epidemiology, and End Results and Central Brain Tumor Registry of the United States. We can use the “big picture” of epidemiology and the new technology of molecular and genetic testing to potentially prevent, diagnose, and tailor treatments in the age of precision medicine.