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Title : Diffuse glioma of the brain stem
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Diffuse glioma of the brain stem

Dear Stephen, dear all!

I ask for advice for my friend, she has a child (8 years old). Diffuse glioma of the brain stem (diagnosed 2015).
March - April 2015 received a course of radiotherapy 54 gray. No chemotherapy.
In January 2017, a new tumor on MRI - less than 5 mm (doctors decided just to observe). In December 2017, MRI showed almost 7 cm tumor.
On January 24, 2018, a biopsy was performed - midline glioma, mutation H3K27M.
March-April 2018, repeated radiotherapy course of 54 gray. No chemotherapy.
November 2018 negative dynamics on MRI.

Mutations:
ATRX - contained in the cores
H3.3 - Mutations detected in the H3.3_K27.M gene
IDH1 - no
p53 - accumulation in nuclei (70% of cells)

1) What can be done in this situation (third radiation therapy, chemotherapy, avastin, dendritic cells, viruses)?
2) Please advise promising clinical studies or clinics that deal with such cases?
3) What drugs could be added due to his mutations?

Thank you!

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