The Current Landscape of Targeted Clinical Trials in Non-WNT/Non-SHH Medulloblastoma

Radiotherapy for Recurrent Medulloblastoma in Children and Adolescents: Survival after Re-Irradiation and First-Time Irradiation

BACKGROUND

Radiotherapy (RT) involving craniospinal irradiation (CSI) is important in the initial treatment of medulloblastoma. At recurrence, the re-irradiation options are limited and associated with severe side-effects.

METHODS

For pre-irradiated patients, patients with re-irradiation (RT2) were matched by sex, histology, time to recurrence, disease status and treatment at recurrence to patients without RT2.

RESULTS

A total of 42 pre-irradiated patients with RT2 were matched to 42 pre-irradiated controls without RT2. RT2 improved the median PFS [21.0 (CI: 15.7-28.7) vs. 12.0 (CI: 8.1-21.0) months] and OS [31.5 (CI: 27.6-64.8) vs. 20.0 (CI: 14.0-36.7) months]. Concerning long-term survival after ten years, RT2 only lead to small improvements in OS [8% (CI: 1.4-45.3) vs. 0%]. RT2 improved survival most without (re)-resection [PFS: 17.5 (CI: 9.7-41.5) vs. 8.0 (CI: 6.6-12.2)/OS: 31.5 (CI: 27.6-NA) vs. 13.3 (CI: 8.1-20.1) months]. In the RT-naïve patients, CSI at recurrence improved their median PFS [25.0 (CI: 16.8-60.6) vs. 6.6 (CI: 1.5-NA) months] and OS [40.2 (CI: 18.7-NA) vs. 12.4 (CI: 4.4-NA) months].

CONCLUSIONS

RT2 could improve the median survival in a matched cohort but offered little benefit regarding long-term survival. In RT-naïve patients, CSI greatly improved their median and long-term survival.

Pathological implications of metabolic reprogramming and its therapeutic potential in medulloblastoma

Tumor-specific alterations in metabolism have been recognized to sustain the production of ATP and macromolecules needed for cell growth, division and survival in many cancer types. However, metabolic heterogeneity poses a challenge for the establishment of effective anticancer therapies that exploit metabolic vulnerabilities. Medulloblastoma (MB) is one of the most heterogeneous malignant pediatric brain tumors, divided into four molecular subgroups (Wingless, Sonic Hedgehog, Group 3 and Group 4). Recent progresses in genomics, single-cell sequencing, and novel tumor models have updated the classification and stratification of MB, highlighting the complex intratumoral cellular diversity of this cancer. In this review, we emphasize the mechanisms through which MB cells rewire their metabolism and energy production networks to support and empower rapid growth, survival under stressful conditions, invasion, metastasis, and resistance to therapy. Additionally, we discuss the potential clinical benefits of currently available drugs that could target energy metabolism to suppress MB progression and increase the efficacy of the current MB therapies.

Potassium Ion Channels in Malignant Central Nervous System Cancers

Malignant central nervous system (CNS) cancers are among the most difficult to treat, with low rates of survival and a high likelihood of recurrence. This is primarily due to their location within the CNS, hindering adequate drug delivery and tumour access via surgery. Furthermore, CNS cancer cells are highly plastic, an adaptive property that enables them to bypass targeted treatment strategies and develop drug resistance. Potassium ion channels have long been implicated in the progression of many cancers due to their integral role in several hallmarks of the disease. Here, we will explore this relationship further, with a focus on malignant CNS cancers, including high-grade glioma (HGG). HGG is the most lethal form of primary brain tumour in adults, with the majority of patient mortality attributed to drug-resistant secondary tumours. Hence, targeting proteins that are integral to cellular plasticity could reduce tumour recurrence, improving survival. This review summarises the role of potassium ion channels in malignant CNS cancers, specifically how they contribute to proliferation, invasion, metastasis, angiogenesis, and plasticity. We will also explore how specific modulation of these proteins may provide a novel way to overcome drug resistance and improve patient outcomes.

Prognostic role of NLGN2 and PTGDS in medulloblastoma based on gene expression omnibus

BACKGROUND

Medulloblastoma (MB) is the most common intracranial malignant tumour in children, but genes and pathways involved in its pathogenesis are still under investigation. This study was designed to screen and identify biomarkers of MB to provide markers for clinical diagnosis and prognosis assessment.

METHODS

The data sets of GSE109401 and GSE42656 were acquired from Gene expression omnibus (GEO). Limma package in R was adopted to identify the differentially expressed genes (DEGs), and the GSE30074 data set was adopted to analyse their prognostic role. Children with MB (n=55) diagnosed in Affiliated Ezhou Central Hospital were enrolled and assigned to the patient group, and healthy children (n=30) who received physical examination in our hospital during the same time period were assigned to the control group. The two groups were compared in serum NLGN2 and PTGDS levels, and all patients were followed up for three years to understand the associations of Neuroligin 2 (NLGN2) and Prostaglandin D2 synthase (PTGDS) with the survival of patients.

RESULTS

With Limma, 247 DEGs were screened out. The LASSO-Cox regression analysis revealed that 6 genes were associated with MB prognosis, and the established model revealed a lower survival rate in the high-risk group. According to Cox regression analysis, NLGN2 and PTGDS may be independent prognostic factors of MB. Similar to the data sets, the Real time-quantitative polymerase chain reaction (RT-qPCR) assay revealed lowly-expressed NLGN2 and PTGDS levels in MB patients, and patients with lower expression of them showed a lower 3-year survival rate.

CONCLUSION

With low expression in MB cases, NLGN2 and PTGDS have high prognostic value for MB.