Genomics in Pediatric High-Grade Gliomas: Hope or Hype: Practical Implications for Resource-Limited Settings

Despite the explosion in molecular understanding for pediatric central nervous system tumors, high-grade gliomas (HGG) are still considered incurable. Therefore the practical benefit of advanced molecular diagnostics for HGG in resource-limited settings can be debated, especially in view of their cost, and limited access to novel-agent clinical trials. This review summarizes the recent WHO 2021 classification for pediatric HGG and focuses on major genomic findings that can significantly impact clinical care, irrespective of geographical location and logistics. Three major areas are highlighted, viz., molecular findings that aid prognostication and treatment decisions, help secure access to novel therapies in resource-limited settings, and aid in the diagnosis of cancer predisposition which impacts care for the family. While building capacity through collaboration and twinning for establishing robust diagnostic assays and clinical trials should remain the ultimate goal, the review proposes how relatively inexpensive assays can be used while caring for children with HGG to potentially improve their outcome.