Facing the future of brain tumor clinical research

Use of virtual reality for symptom management in solid-tumor patients with implications for primary brain tumor research: a systematic review

Background

Primary brain tumors (PBTs) remain incurable, with a typically poor prognosis and significant symptom burden for patients. Virtual reality (VR) can potentially alleviate some of the negative aspects of illness by allowing individuals to escape to environments where they can experience more positive thoughts and emotions. Given promising findings for VR use in other clinical populations, there is increasing interest to use VR for symptomatic improvement in oncology patients. The purpose of this review was to analyze the literature of VR-related interventions for symptom management in adult PBT and other solid-tumor patients, which will guide development of future VR interventions in these populations.

Methods

A systematic search of EMBASE, PubMed, Scopus, and Web of Science was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with predefined eligibility criteria. Thirteen studies met the inclusion criteria and were selected for review.

Results

Findings showed promising evidence that VR can improve anxiety for solid-tumor patients, with mixed results reported for pain, distress, depression, and mood. There was significant heterogeneity in methodological approaches across the literature and the majority of studies were underpowered and lacked rigorous study designs. Qualitative findings demonstrated a high degree of participant satisfaction with VR use, with very few adverse side effects reported.

Conclusions

Findings from this review suggest that VR can be used as an innovative delivery system for targeted interventions to improve symptoms in PBTs and other solid-tumor patient populations, though additional well-designed clinical trials are needed to better establish its efficacy.

Molecularly Targeted Agents in the Therapy of Pediatric Brain Tumors

Pediatric brain tumors are the leading cause of cancer-related death in children. Recent advances in sequencing techniques, and collaborative efforts to encode the mutational landscape of various tumor subtypes, have resulted in the identification of recurrent mutations that may present as actionable targets in these tumors. A number of molecularly targeted agents are approved or in development for the treatment of various tumor types in adult patients. Similarly, these agents are increasingly being incorporated into pediatric clinical trials, allowing for a targeted approach to treatment. However, due to the genetic heterogeneity of these tumors, focused clinical trials in pediatric patients are challenging and regulatory hurdles may delay access to therapeutic compounds that are in regular use in adult patients. The tumor site-agnostic clinical development of TRK inhibitors for pediatric solid tumors is a current example of how the combination of genetic testing and innovative clinical trial design can accelerate the clinical development of targeted agents for pediatric patients.

Experimental Therapeutic Trial Design for Pediatric Brain Tumors

Pediatric brain tumors are the leading cause of cancer-related death during childhood. Since the first pediatric brain tumor clinical trials, the field has seen improved outcomes in some, but not all tumor types. In the past few decades, a number of promising new therapeutic agents have emerged, yet only a few of these agents have been incorporated into clinical trials for pediatric brain tumors. In this review, the authors discuss the process of and challenges in pediatric clinical trial design; this will allow for highly efficient and effective clinical trials with appropriate endpoints to ensure rapid and safe investigation of novel therapeutics for children with brain tumors.