Canadian Consensus for Treatment of BRAF V600E Mutated Pediatric and AYA Gliomas
Craig Erker, Magimairajan Vanan, Valérie Larouche, Liana Nobre, Chantel Cacciotti, Stéphanie Vairy, Shayna Zelcer, Adam Fleming, Éric Bouffet, Nada Jabado, Geneviève Legault, Samuele Renzi, Tara McKeown, Bruce Crooks, Nirav Thacker, Vijay Ramaswamy, Hallie Coltin, Lucie Lafay‐Cousin, Sylvia Cheng, Juliette Hukin, Seth Climans, Mary Jane Lim-Fat, Sarah McKillop, Sarah Lapointe, Mélanie Alves, Julie Bennett, Uri Tabori, Sébastien Perreault
Abstract
Background: The treatment of BRAF V600E gliomas with BRAF inhibitors (BRAFis) and MEK inhibitors (MEKis) has been increasingly integrated into clinical practice for pediatric low-grade gliomas (PLGGs) and pediatric high-grade gliomas (HGGs). However, some questions remain unanswered, such as the best time to start targeted therapy, duration of treatment, and discontinuation of therapy. Given that no clinical trial has been able to address these critical questions, we developed a Canadian Consensus statement for the treatment of BRAF V600E mutated pediatric as well as adolescent and young adult (AYA) gliomas. Methods: Canadian neuro-oncologists were invited to participate in the development of this consensus. The consensus was discussed during monthly web-based national meetings, and the algorithms were revised until a consensus was achieved. Results: A total of 26 participants were involved in the development of the algorithms. Two treatment algorithms are proposed, one for the initiation of treatment and one for the discontinuation of treatment. We suggest that most patients with BRAF V600E gliomas should be treated with BRAFis ± MEKis upfront. Discontinuation of treatment can be considered in certain circumstances, and we suggest a slow wean. Conclusions: Based on expert consensus in Canada, we developed algorithms for treatment initiation of children and AYA with BRAF V600E gliomas as well as a discontinuation algorithm.