Medical Treatment of Pediatric Low-Grade Glioma

Abstract

Low-grade glioma (LGG) is the most common brain tumor in children and has excellent long-term survival. With an excellent survival rate, the choice of treatment involves careful consideration of minimizing late toxicity from surgery, radiation, and chemotherapy. Surgery, radiation therapy, and chemotherapy can be used as monotherapy or in combination, providing different therapeutic ratios and complications. As a result, establishing the selection of ideal therapies has been a controversial area, presenting challenges. Recent advances in understanding molecular characteristics of pediatric LGG affect classification and treatment approaches. This review aims to overview recent developments in medical treatment in pediatric LGG.

Bevacizumab-Irinotecan combination therapy in recurrent low-grade glioma, previously treated with chemo-radiotherapy: a case report

“…Chemotherapy has been considered for young children with incompletely resected pediatric LGGs, to delay radiotherapy, and for recurrent tumors in unfavorable locations as hypothalamic or pineal gliomas ( 3 ). Multiple chemotherapeutic regimens have been employed in children with LGGs ( 1 ).…”

“…However, at least half of children with LGGs treated with front line chemotherapy experience a relapse/progression and may therefore need a second-line chemotherapy ( 2 ). Recent advances in understanding molecular characteristics of pediatric LGGs have affected classification and treatment approaches ( 3 ). Various agents that target the MAPK pathway, such as MEK, BRAF, mTOR inhibitors, are currently attempted in pediatric LGGs with encouraging results ( 3 ).…”

“…Recent advances in understanding molecular characteristics of pediatric LGGs have affected classification and treatment approaches ( 3 ). Various agents that target the MAPK pathway, such as MEK, BRAF, mTOR inhibitors, are currently attempted in pediatric LGGs with encouraging results ( 3 ).…”

STAT3 drives the malignant progression of low-grade gliomas through modulating the expression of STAT1, FOXO1, and MYC

“…With the concept of precision medicine, targeted therapy and immune therapy have been proposed and used in the treatment of LGG ( Bao et al, 2022 ; Haddad et al, 2022 ; Lim, 2022 ; Lucke-Wold et al, 2024 ). Drugs targeting cyclin-dependent kinase 9 (CDK9), programmed cell death protein-1 (PD-1), and other proteins have been used in clinical trials to treat glioma ( Lucke-Wold et al, 2024 ).…”

“…Drugs targeting cyclin-dependent kinase 9 (CDK9), programmed cell death protein-1 (PD-1), and other proteins have been used in clinical trials to treat glioma ( Lucke-Wold et al, 2024 ). Despite the numerous advancements in targeted therapy and immune therapy for LGG that have been developed in the past decades, the definitive improvement in clinical diagnosis and treatment remains limited and insufficient ( Haddad et al, 2022 ; Lim, 2022 ; Lucke-Wold et al, 2024 ). The widely poor prognosis of LGG can be attributed to the great genetic heterogeneity in their clinical behavior ( Wang and Mehta, 2019 ; Ryall et al, 2020 ).…”