Molecular testing for adolescent and young adult central nervous system tumors: A Canadian guideline

Mary Jane Lim-Fat; Maria Macdonald; Sarah Lapointe; Seth Andrew Climans; Chantel Cacciotti; Manik Chahal; Sebastien Perreault; Derek S Tsang; Andrew Gao; Stephen Yip; Julia Keith; Julie Bennett; Vijay Ramaswamy; Jay Detsky; Uri Tabori; Sunit Das; Cynthia Hawkins

doi:10.3389/fonc.2022.960509

Molecular testing for adolescent and young adult central nervous system tumors: A Canadian guideline

Front Oncol. 2022 Sep 23:12:960509. doi: 10.3389/fonc.2022.960509. eCollection 2022.

Authors

Mary Jane Lim-Fat¹, Maria Macdonald², Sarah Lapointe³, Seth Andrew Climans², Chantel Cacciotti⁴, Manik Chahal⁵, Sebastien Perreault⁶, Derek S Tsang⁷, Andrew Gao⁸, Stephen Yip⁹, Julia Keith¹⁰, Julie Bennett¹¹, Vijay Ramaswamy¹¹, Jay Detsky¹², Uri Tabori¹¹, Sunit Das¹³, Cynthia Hawkins¹⁴

Affiliations

¹ Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
² Department of Oncology, London Health Sciences Centre, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
³ Division of Neurology, Department of Medicine, Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada.
⁴ Department of Paediatrics, Division of Pediatric Hematology/Oncology, London Health Sciences Centre, London, ON, Canada.
⁵ Department of Medical Oncology, BC Cancer Vancouver Centre, Vancouver, BC, Canada.
⁶ Department of Pediatrics, Division of Child Neurology, CHU Sainte-Justine, Montreal, QC, Canada.
⁷ Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
⁸ Department of Laboratory Medicine and Pathobiology, University Health Network, University of Toronto, Toronto, ON, Canada.
⁹ Department of Pathology & Laboratory Medicine, Faculty of Medicine, University of British Columbia, BC, Canada.
¹⁰ Department of Laboratory Medicine and Pathobiology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada.
¹¹ Division of Haematology/Oncology, The Hospital for Sick Children, Toronto ON, Canada.
¹² Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada.
¹³ Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
¹⁴ Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto ON, Canada.

Abstract

The 2021 World Health Organization (WHO) classification of CNS tumors incorporates molecular signatures with histology and has highlighted differences across pediatric vs adult-type CNS tumors. However, adolescent and young adults (AYA; aged 15-39), can suffer from tumors across this spectrum and is a recognized orphan population that requires multidisciplinary, specialized care, and often through a transition phase. To advocate for a uniform testing strategy in AYAs, pediatric and adult specialists from neuro-oncology, radiation oncology, neuropathology, and neurosurgery helped develop this review and testing framework through the Canadian AYA Neuro-Oncology Consortium. We propose a comprehensive approach to molecular testing in this unique population, based on the recent tumor classification and within the clinical framework of the provincial health care systems in Canada.

Contributions to the field: While there are guidelines for testing in adult and pediatric CNS tumor populations, there is no consensus testing for AYA patients whose care occur in both pediatric and adult hospitals. Our review of the literature and guideline adopts a resource-effective and clinically-oriented approach to improve diagnosis and prognostication of brain tumors in the AYA population, as part of a nation-wide initiative to improve care for AYA patients.

Keywords: AYA; CNS tumor classification; molecular testing; precision oncology; targeted therapy.

Publication types

Review