INNV-10. GLIOMAS IN ADOLESCENTS AND YOUNG ADULTS – EXPERIENCE OF CASES PRESENTED AT NATIONAL AYA MULTI-DISCIPLINARY ROUNDS
Bibliographic record
Abstract
Abstract INTRODUCTION Gliomas are the most common brain tumor in adolescents and young adults (AYA). IDH mutations are common in this population, though up to 30% of gliomas in AYA harbor a pediatric-type alteration including alterations in RAS/MAPK pathway and histone mutations. These can present a diagnostic and management dilemma in young adults given the limited data in this population. Here, we aim to describe glioma cases submitted for multi-disciplinary AYA rounds. METHODS Gliomas presented at the Canadian AYA Neuro-Oncology Network (CANON) rounds between April 2021 and June 2023 were compiled. Patient demographics, tumor histology and molecular alterations are described. Recommendations and themes from the multi-disciplinary rounds were summarized. RESULTS Of 132 cases presented, 96 were gliomas. Median age was 28 years (range 15-59). Twelve (12.5%) cases were IDH-mutant. Remaining cases included low grade glioma (LGG, n=37, 38.5%), IDH-WT high grade gliomas (HGG, n=22, 22.9%) and diffuse midline glioma (n=13, 13.5%). Of the LGGs, 13 gliomas had FGFR-alteration, 9 had BRAF-alteration, 3 had NF-1 with 4 having rare alterations typically seen in children (KRAS, NTRK fusion, PDGFRa K385-mut). Recommendations included discussion to start targeted therapy or management of toxicities due to targeted inhibitors in 16 cases. Of the HGGs, 7 (31.8%) had underlying cancer predisposition syndrome (NF-1 n=4, mismatch repair deficiency n=3). Management questions included role of re-resection, timing of radiation, duration of targeted therapies and access to targeted agents through clinical trials or compassionate access programs. CONCLUSION Within national rounds, there was enrichment of pediatric-type tumors and patients with cancer predisposition syndromes. Targeted agents are available for many of these driver mutations with potential improved outcomes; however, access to these agents in AYA may be limited. Clinicians face complex management questions in this population and underscores the need for a multi-disciplinary approach along with clinical trial opportunities for these patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".