Canadian Consensus for Treatment of BRAF V600E Mutated Pediatric and AYA Gliomas
, Magimairajan Issai Vanan 3, Valérie Larouche 4, Liana Nobre 5, Chantel Cacciotti 6, Stéphanie Vairy 7, Shayna Zelcer 6, Adam Fleming 8, Eric Bouffet 9,10, Nada Jabado 11, Geneviève Legault 11, Samuele Renzi 4, Tara McKeown 9,10, Bruce Crooks 1,2, Nirav Thacker 12, Vijay Ramaswamy 9,10, Hallie Coltin 13, Lucie Lafay-Cousin 14, Sylvia Cheng 15, Juliette Hukin 15, Seth Andrew Climans 16, Sarah Lapointe 19,20, add
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Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsCancer being a very complex disease, options/logistics for treatment of patients with cancer can be quite challenging even when a potential therapy regimen is available. Approach to therapy can also vary based on a multitude of factors resulting in variability of treatment outcomes. A rational approach to minimize variation of treatment results can be to develop a consensus for treatment by the providers.
Conceptually, such a consensus can be formulated by careful discussions of various treatment parameters by providers who are treating the same disease with the same treatment regimen. Erker et al., in my mind, have exactly done this. I must say, their efforts and approach are commendable, rational, and imitable.
Since treatment of pediatric low- and high-grade gliomas (PLGG and PHGG) with BRAF V600E mutation is treated with BRAF and MEK inhibitors (BRAFi and MEKi), two simple but important questions were asked by Erker et al to formulate a consensus by the providers. The questions are: when to start the targeted therapy and when to discontinue the therapy? The authors have discussed these questions via multiple settings among 26 provider participants located in various regions in Canada and developed a consensus/algorithm to address the questions. Overall, I find their approach prudent, practical, and patient-centered.
Author Response
Thank your comments. It is appreciated
Reviewer 2 Report
Comments and Suggestions for AuthorsThis consensus statement by Erker et al aims to help clinicians who deal with a specific set of issues as it pertains to patients with gliomas who have BRAF V600E mutations. There are few robust studies in this population. This is helpful for clinicians with the caveat that this is based more on expert opinion than data-driven. In rare/ultra-rare diseases, statements like this can help clinicians and patients navigate the complex issues surrounding management.
Author Response
Thank you for your comments. It is appreciated
