Pediatric versus adult high grade glioma: Immunotherapeutic and genomic considerations

Abstract

High grade gliomas are identified as malignant central nervous tumors that spread rapidly and have a universally poor prognosis. Historically high grade gliomas in the pediatric population have been treated similarly to adult high grade gliomas. For the first time, the most recent classification of central nervous system tumors by World Health Organization has divided adult from pediatric type diffuse high grade gliomas, underscoring the biologic differences between these tumors in different age groups. The objective of our review is to compare high grade gliomas in the adult versus pediatric patient populations, highlighting similarities and differences in epidemiology, etiology, pathogenesis and therapeutic approaches. High grade gliomas in adults versus children have varying clinical presentations, molecular biology background, and response to chemotherapy, as well as unique molecular targets. However, increasing evidence show that they both respond to recently developed immunotherapies. This review summarizes the distinctions and commonalities between the two in disease pathogenesis and response to therapeutic interventions with a focus on immunotherapy.

Novel insights on genetics and epigenetics as clinical targets for paediatric astrocytoma

“…Even though the histopathologic features of high-grade gliomas (HGG) are similar in children and adults, the molecular paradigms underlying these tumours differ significantly leading to different management regimens in children as compared to adults. [46][47][48] According to the recent classification changes, highgrade tumours include DMG, H3 K27-altered, diffuse hemispheric glioma, H3 G34-mutant, diffuse hemispheric glioma and H3 G34-mutant infant-type hemispheric glioma. However, neurooncologists and neuropathologists are still advocating for more clarification on the classification of paediatric tumours.…”

“…Histopathological features of DIPG are similar to that of pGBM with the majority of tumours showing necrotic features, microvascular proliferation and mitotic structures. Even though the histopathologic features of high‐grade gliomas (HGG) are similar in children and adults, the molecular paradigms underlying these tumours differ significantly leading to different management regimens in children as compared to adults 46–48 …”

“…Even though the histopathologic features of high‐grade gliomas (HGG) are similar in children and adults, the molecular paradigms underlying these tumours differ significantly leading to different management regimens in children as compared to adults. 46 , 47 , 48 …”

Case report: complete long-lasting response to multimodal third line treatment with neurosurgical resection, carmustine wafer implantation and dabrafenib plus trametinib in a BRAFV600E mutated high-grade glioma

“…High-grade gliomas (HGGs), tumors of neuroepithelial origin ( 1 ), represent the most common primary intracranial tumor in adults ( 2 , 3 ). Differently, low- grade gliomas (LGGs) predominate in children ( 4 , 5 ).…”

Cancer vaccine strategies for the treatment of diffusely infiltrating gliomas

“… 13 Pediatric high-grade gliomas on the other hand can be characterized into four distinct categories using their histone mutation status to delineate categories. 14 The four types are diffuse midline glioma (DMG) H3 K27-altered, diffuse hemispheric glioma H3 G34-mutant, diffuse pediatric-type high-grade glioma H3-wildtype IDH-wildtype, and finally infant-type hemispheric glioma. 11 For all entities mentioned above, treatment revolves around three main pillars: when the tumor is deemed operable, the patient will undergo surgery, followed by chemotherapy with temozolomide (TMZ), and radiotherapy.…”