Brain and spinal cord
Rare cancer of the brain and spinal cord
Here again, histological and molecular diagnosis requires expert centers. Case classifications further add complexity to the field and the development of clinical and translational research, in particular with new agents.
The revised World Health Organization (WHO) classification of brain tumours, published in 2016, marked the entry of neuro-oncology into the era of molecular precision medicine. Since WHO 2016, the case classification of primary brain tumours is not only based on pathology but also molecular biology, allowing individualization of particular entities based on both pathological and molecular features.
Close to one hundred and fifty entities have been listed in the WHO 2016 classification.
The most common primary brain tumours are diffuse glial tumours including astrocytomas and oligodendrogliomas from grades II to IV.
Other types of rare brain tumours can be merged into a number of clinically relevant groups: (i) medulloblastoma and embryonal tumours, (ii) pineal region tumours, (iii) glioneuronal tumours and rare glial tumours, (iv) ependymal tumours, (v) grade III meningioma and mesenchymal non-meningothelial tumours, (vi) primary central nervous system lymphoma and hematological diseases, (vii) central nervous system germ cell tumours, (viii) spinal cord tumours and, (ix) rare pituitary tumours.
These nine groups of brain tumours are ultra-rare and require collaborative and synergistic Europe-wide, multidisciplinary collaboration to achieve significant biological and clinical advances in the setting of clinical trials which would otherwise be hard to conduct in a single country or trial site.
As an example, in oligodendroglioma, collaborative work within the Brain Tumour Group of the European Organization for Research and Treatment of Cancer (EORTC) has allowed identification of robust diagnostic, prognostic and predictive molecular biomarkers and appropriate treatments which doubled the median overall survival of patients. Similar efforts and results were obtained from our North American colleagues.
Importantly, meaningful advances and improved outcomes for brain tumour patients cannot be made without the involvement of European Patient Advocacy Groups (ePAGs) which help identify patients’ and caregivers’ research priorities, perspectives and preferences. Within EURACAN’s Domain 10, the International Brain Tumour Alliance (IBTA–www.theibta.org), is serving as the Domain 10 ePAG and point of contact for patient involvement within our ERN. The IBTA contributes broadly to the definition of guidelines, communication tools and research strategies. Through their action as leaders of the transversal task force on communication and dissemination, the experience gained by ePAGs through collaborations with health care providers (HCPs) and collaborative groups, IBTA serves as a model advocacy group for other domains, providing insight and guidance to other ePAGs.
We hope that, within the framework of the ERN EURACAN, Domain 10 will make significant and durable progress in the neuro-oncology field.