Precision Neuro-oncology: the Role of Genomic Testing in the Management of Adult and Pediatric Gliomas

Lori A. Ramkissoon, Nicholas Britt, Alexander Guevara, Emily Whitt, Eric Severson, Pratheesh Sathyan, Laurie Gay, Julia Elvin, Jeffrey S. Ross, Charlotte Brown, Kimberly Stogner-Underwood, Ryan Mott, David Kram, Roy Strowd, Glenn J. Lesser, Shakti H. Ramkissoon

In recent years, large-scale genomic studies have expanded our knowledge regarding genomic drivers in tumors of the central nervous system. While histopathologic analysis of brain tumors remains the primary method for tumor classification, the clinical utility of molecular and genomic testing to support and/or complement tumor classification continues to expand. This approach enhances diagnostic accuracy and provides clinicians with objective data to facilitate discussions regarding prognosis and treatment decisions, including selection of clinical trials. Ensuring accurate diagnoses is fundamental to the management of brain tumor patients. However, given the morphologic overlap among primary brain tumors, genomic data can be used to help distinguish tumor lineage. In its clearest form, we have embraced the concept of an integrated diagnosis, which combines traditional histopathology findings with molecular and genomic data. Patient prognosis varies significantly based on a tumor's genomic profile. For neuro-oncology patients, outcome studies linking diagnoses with genomic profiles show significant differences based on tumor biomarkers such as IDH1/2, H3F3A, BRAF, and CDKN2A and TERT status. Therefore, easy access to reliable genomic data is important in understanding a patient's disease and developing a clinical strategy wherein targeted molecular or immune therapies can be incorporated into the discussion.