Treatment of pediatric oncology patients generally results in significant immunosuppression and when the COVID-19 pandemic arose, there was concern among pediatric oncologists about the implications of this virus. We reviewed the literature and describe all pediatric oncology patients with COVID-19 reported worldwide. Within this review, it is striking that CNS tumors are reported at low numbers (27/466 pediatric oncology patients with COVID-19). This may be related to decreased inpatient care when compared to other pediatric cancers. Additional work is needed to understand the risk of infection in this population and gain insight into the effect on delivery of oncology care.
CNS high-grade neuroepithelial tumor with MN1 alteration (CNS HGNET-MN1) is a rare entity recently described. Thirteen CNS HGNET-MN1 patients were identified using genome wide methylation arrays/RT-PCR across 7 institutions and were correlated with treatment and outcome. All patients had surgery (GTR:9/STR:4) as initial management followed by radiotherapy (focal:5/craniospinal:2/CyberKnife:1) and systemic chemotherapy in 3 patients. Seven patients relapsed; 5 local and 2 metastatic despite complete resection and radiotherapy. Three patients died due to their tumor relapse after 24 months despite upfront radiotherapy. Treatment of CNS HGNET-MN1 remains a major challenge with multiple failures, despite aggressive surgical resections and upfront radiotherapy.
Targeted therapies are increasingly used in the management of pediatric low grade glioma. How-ever for patients who show resistance to these treatments, limited options are available. We pre-sent the case of a patient with BRAFV600 mutated low grade glioma who showed progression on a combination of trametinib and dabrafenib. Discontinuation of treatment was associated with a life-threatening deterioration and reintroduction of targeted therapy had no effect. The patient eventually showed a dramatic response to TPCV (thiguanine, procarbazine, CCNU and vincris-tine) , which suggests a role of chemotherapy in these situations.