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Biologically Targeted Therapeutics in Pediatric Brain Tumors

  • Amulya A. Nageswara Rao
    Affiliations
    Division of Pediatric Hematology/Oncology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota

    Department of Neurology and Pediatrics, George Washington University, Washington, DC

    Brain Tumor Institute, Children’s National Medical Center, Washington, DC

    Center for Neuroscience and Behavioral Medicine, Children’s National Medical Center, Washington, DC
    Search for articles by this author
  • Joseph Scafidi
    Affiliations
    Department of Neurology and Pediatrics, George Washington University, Washington, DC

    Brain Tumor Institute, Children’s National Medical Center, Washington, DC

    Center for Neuroscience and Behavioral Medicine, Children’s National Medical Center, Washington, DC
    Search for articles by this author
  • Elizabeth M. Wells
    Affiliations
    Department of Neurology and Pediatrics, George Washington University, Washington, DC

    Brain Tumor Institute, Children’s National Medical Center, Washington, DC

    Center for Neuroscience and Behavioral Medicine, Children’s National Medical Center, Washington, DC
    Search for articles by this author
  • Roger J. Packer
    Correspondence
    Communications should be addressed to: Dr. Packer; Department of Neurology; Children’s National Medical Center; 111 Michigan Avenue NW; Washington, DC 20010.
    Affiliations
    Department of Neurology and Pediatrics, George Washington University, Washington, DC

    Brain Tumor Institute, Children’s National Medical Center, Washington, DC

    Center for Neuroscience and Behavioral Medicine, Children’s National Medical Center, Washington, DC
    Search for articles by this author

      Abstract

      Pediatric brain tumors are often difficult to cure and involve significant morbidity when treated with traditional treatment modalities, including neurosurgery, conventional chemotherapy, and radiotherapy. During the past two decades, a clearer understanding of tumorigenesis, molecular growth pathways, and immune mechanisms in the pathogenesis of cancer has opened up promising avenues for therapy. Pediatric clinical trials with novel biologic agents are underway to treat various pediatric brain tumors, including high and low grade gliomas and embryonal tumors. As the therapeutic potential of these agents undergoes evaluation, their toxicity profiles are also becoming better understood. These agents have potentially better central nervous system penetration and lower toxicity profiles compared with conventional chemotherapy. In infants and younger children, biologic agents may prove to be of equal or greater efficacy compared with traditional chemotherapy and radiation therapy, and may reduce the deleterious side effects of traditional therapeutics on the developing brain. Molecular pathways implicated in pediatric brain tumors, agents that target these pathways, and current clinical trials are reviewed. Associated neurologic toxicities will be discussed subsequently. Considerable work is needed to establish the efficacy of these agents alone and in combination, but pediatric neurologists should be aware of these agents and their rationale.
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