%0 Journal Article
%T Precision Medicine for Primary Central Nervous System Tumors: Are We There Yet?
%A Franziska Maria Ippen
%A Howard Colman
%A Martin J. van den Bent
%A Priscilla Kaliopi Brastianos
%J About the Ed Book | ASCO Educational Book
%D 2018
%R https://doi.org/10.1200/EDBK_199247
%X Over the past few decades, the widespread availability of improved sequencing techniques has contributed immensely to our understanding of the cancer genome and therefore also to our knowledge of clinically actionable mutations in brain tumors. The discovery of a variety of genetic driver mutations in these tumors has enabled us to integrate these findings into the diagnostic process and to implement targeted treatment strategies in affected patients by directing them to appropriate clinical trials. Here we summarize recently discovered driver mutations in low-grade gliomas, glioblastomas (GBMs), craniopharyngiomas, and meningiomas and discuss the diagnostic and therapeutic implications of these findings. TARGETED TREATMENT OF LOW-GRADE GLIOMA Section: ChooseTop of pageAbstractTARGETED TREATMENT OF LOW... <<NOVEL MOLECULAR TARGETS I...PRECISION MEDICINE IN CRA...CONCLUSIONREFERENCES On the Involved Tumor Entities Low-grade gliomas are generally considered World Health Organization (WHO) grade 1 or 2 tumors, but the current WHO classification and its emphasis on molecular characteristics has made the distinction between tumor grades less clear. The revised classification now emphasizes molecular similarities, with only minimal morphologic and subjective differences between grades 2 and 3. This is reflected in the decreased difference in survival between grades 2 and 3 IDH-mutant (IDHmt) astrocytoma, and, taken together, this suggests more of a continuum between grades. Instead, the WHO appropriately now distinguishes between types of IDHmt glioma (astrocytoma for those 1p/19q intact and oligodendroglioma if 1p/19q is codeleted). There is now compelling evidence that patients with grade 2 or 3 IDH wild-type glioma with TERT mutations and polysomy of chromosome 7 plus loss of heterozygosity of chromosome 10q have similar outcomes compared with those with GBM.1,2 In light of this, when considering targeted treatment of gliomas, the focus should not be so much on grade but on the molecular targets. O-6-Methylguanine-DNA Methyltransferase Targeted cancer therapies are drugs that block the growth and spread of cancer by interfering with specific molecules that are involved in the growth, progression, and spread of cancer.3 If O-6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status is considered, alkylating and methylating chemotherapy can be considered targeted treatments. Lomustine and temozolomide are particularly effective in the presence of a methylated MGMT promoter. In most tumors with an IDH mutation, a so-called CpG island
%U http://ascopubs.org/doi/full/10.1200/EDBK_199247