More than 400 neurologists, neurosurgeons, pathologists, pediatricians, clinical and basic scientists gathered in Hong Kong for Brain 2019, a conjoint congress of the 3rd Asian Central Nervous System Germ Cell Tumour Conference (CNSGCT), the 9th Interim Meeting of the International Chinese Federation of Neurosurgical Sciences (ICFNS) and the 16th Asia Pacific Multidisciplinary Meeting for Nervous System Diseases (BRAIN) which is also jointly organized by The Chinese University of Hong Kong. This three-day convention discussed advances in pediatric neuro-oncology and neuro-rehabilitation.
Invited as the 2019 Otto Lien Da Wong (OLDW) visiting professor in neuro-oncology, Roger J. Packer, M.D., senior vice president for the Center of Neuroscience and Behavioral Medicine and director at the Gilbert Neurofibromatosis and Brain Tumor Institutes, presented a keynote address titled “Advances in Pediatric Brain Tumors.” Established in 2009, the purpose of the visiting professorship is to advance surgical knowledge and techniques in neuro-oncology between Hong Kong and major medical centers around the world. Dr. Packer was selected from an international field of acclaimed academic surgeons and scholars in the field of neuro-oncology. Two additional presentations included “Pediatric Brain Tumors in Molecular Era: Germ Cell Tumors” as an invited guest of the BRAIN conference and a presentation on “Treatment of Medulloblastoma and PNET” as a session presented by the ICFNS.
In addition to his presentations, Dr. Packer will participate in surgical teaching and scholastic exchange with local surgeons, surgical trainees and medical students.
For more than three decades, the world’s pre-eminent scientists and clinicians in pediatric neuro-oncology have convened the International Symposium on Pediatric Neuro-oncology every two years. Their goal is to advance the care and treatment of pediatric brain and central nervous system tumors by connecting across disciplines to share research findings and discuss the latest treatment approaches.
This year for the first time, representatives from parent advocacy groups and patient support foundations were also invited to attend the traditionally scientific meeting. Their inclusion allowed care providers and scientific investigators to make sure the voices of patients and families, and their needs, are heard.
Roger J. Packer, M.D., senior vice president of the Center for Neuroscience and Behavioral Medicine at Children’s National Health System, served as international organizing committee chair this year. He was chair and organizer of the very first symposium, held in 1986, and has led additional sessions over the years.
Dr. Packer had the honor of giving the opening keynote address to more than 1,200 participants in Denver this year. He used his lecture to highlight some of the amazing knowledge leaps made in the last decade in understanding the molecular makeup and genetics behind brain and spinal cord tumors.
“We’ve made more discoveries in these areas in the last 10 years than we made in the 50 years before that. It’s been a phenomenal decade for discovery,” he notes. “But the fact remains we have not yet been able to translate all of this knowledge into more effective therapies for most children with brain and central nervous system cord tumors.”
Dr. Packer says progress made in managing and treating childhood low grade gliomas is one example of how care should move forward for other tumor types. The unique genetic and molecular makeup of low grade gliomas, which are the single most common form of childhood low grade tumor, has allowed clinicians to begin moving away from surgeries, radiation therapy and chemotherapy toward less neurotoxic treatments targeted at the specific molecular properties of the tumor itself.
“Although the chemotherapy protocol we began for low-grade gliomas 30 years ago works well and is still the standard of care today, the new molecular approaches we and others have tested will hopefully replace it soon and result in even better outcomes,” he adds.
Medulloblastoma, the most common form of malignant brain tumor, is one area Dr. Packer notes could stand to benefit from therapies with less impact on a child’s quality of life. The current treatment protocol used for this childhood tumor also remains the same as the one that Dr. Packer helped develop more than 30 years ago.
“Our protocol is effective, and we’ve moved survival from 50 percent to 80 percent for these types of tumors using this approach, but it’s time to determine how best to move toward effective molecularly targeted therapies that would allow us to reduce the neurotoxic treatments necessary to treat these tumors.”
“We have to move from our decade of discovery to a decade of no excuses where we are able to use what we’ve learned to improve the care of all childhood brain and spinal cord tumors,” he says.
Dr. Packer says the key is to avoid getting paralyzed by the mountain of molecular data that is available and really focus on the specific information needed to make treatments more precise.
One promising new approach is the use of immunotherapy for pediatric brain and spinal cord tumors. Children’s National and colleagues from across the U.S. are at the forefront of developing these therapies to control tumor growth, and presented several related studies at ISPNO:
- Eugene Hwang, M.D. presented the findings from immunotherapy clinical trials for brain and central nervous system tumors, including diffuse intrinsic pontine glioma (DIPG).
- Karin Walsh, Psy.D., shared new data demonstrating the reduced neurotoxicity of a new molecularly targeted agent.
There were also several poster session presentations where Dr. Hwang, Lindsey Kilburn, M.D., Brian Rood, M.D., and others from the Children’s National team shared findings related to the potential and the challenges of molecular targeted therapies, especially immunotherapies. The team at Children’s also presented data related to new findings about how to reverse neurologic and neurocognitive deficits that often result from these conditions, including some that for years were thought to be irreversible, such as vision deficits.
Dr. Packer notes that many of the newest clinical trials both in the U.S. and internationally have the potential to kick start this decade of “no excuses.”
“We’ve made great progress, but we haven’t yet been able to take full advantage of the knowledge we’ve amassed. To do it, we all have to work together as a community nationally and internationally to change the paradigms of how we treat these children and make meaningful advances.”
Patients with low-grade gliomas (LGGs) will benefit from new recommendations from a group led by Roger J. Packer, M.D., senior vice president for the Center for Neuroscience and Behavioral Medicine, as well as clinicians, researchers and industry leaders from around the world, that were recently published in Neuro-Oncology. The new framework for LGGs will significantly advance the future of care for patients with these complex diseases and set a new path to expedite the translation of scientific advances into clinical care. The recommendations build on a treatment approach developed more than 25 years ago by Dr. Packer and his colleagues that revolutionized care for LGGs.
LGGs are both common and complicated, and one treatment approach does not work for all cases. Until now, there has not been a standardized way to categories the tumors to prescribe more effective and personalized treatment options. The new guidelines will provide clinicians with one mutually agreed upon set of recommendations to further advance the field and better diagnose and treat patients with LGGs.
Topics within the framework include:
- Implications of the growing understanding of genomics underlying these tumors and how to apply to clinical practice
- The need for more and better model systems to assess the likely benefits of new treatments for LGGs before exposing patients to new therapy
- A review and assessment of what is needed for the design of future clinical trials
- Evaluation of current therapies and the steps needed to expedite molecularly targeted therapy into late-stage clinical trials, including in those newly diagnosed with the disease so as to avoid less-personalized chemotherapy or radiotherapy
“We believe our understanding of LGGs combined with novel therapies will soon lead to a new standard of care for children,” says Dr. Packer. “We are optimistic about the future for patients with this disease.”
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