Molecular genetic testing features prominently in the National Comprehensive Cancer Network’s (NCCN’s) new guidelines (registration required for access) for diagnosing and treating children with brain cancer.
Up to now, the NCCN has addressed pediatric central nervous system (CNS) tumors as part of its broader guidelines for treating any patients with brain cancer. However, “treating children with cancer is very different from adults, particularly for CNS tumors,” noted Amar Gajjar, MD, the chair of the Pediatric CNS Cancers Panel, in a press release. Published on July 12, the NCCN guidelines provide evidence-based recommendations across treatment disciplines exclusively for pediatric cancer.
Molecular tests should be used to determine high-grade versus low-grade tumors and home in on alterations that have prognostic relevance and treatment implications, according to the guidelines. Molecular testing for adults is relatively simple, with the focus on distinguishing isocitrate dehydrogenase (IDH)-mutant from IDH-wild-type gliomas. However, the guidelines note, pediatric tumors frequently exhibit a high degree of histologic overlap and non-specificity of histologic features amongst the numerous recognized pathologic entities. Underlying molecular alterations in pediatric gliomas are also distinct from those in adults. “This underscores the immense importance of molecular testing in pediatric tumor diagnostics.”
The express recommendation for molecular profiling in pediatric brain cancer could prove highly significant given how much influence the NCCN has on both treatment decisions made by oncologists and coverage and reimbursement policies implemented by payors.
Look for a more in-depth report on the new guidelines in an upcoming issue of Diagnostic Testing & Emerging Technologies.