Immunotherapy and the Immune Infiltrate in Pediatric Brain Tumors: An Illustration and Review of the Unique Challenges Facing Immunotherapy for Pediatric Oncology

Immunotherapy for pediatric oncology is a robust and prolific area of active research and has changed the face of treatment for some cancers, such as, B cell acute lymphoblastic leukemia (ALL) and neuroblastoma. However, the field faces challenges and hurdles unique to the pediatric population especially in the area of neuro-oncology. Here, clinicians face challenges of using immunotherapy for tumors with some of the lowest mutational burdens in sensitive areas of the brain where surgical intervention is limited and significant immune infiltration is poorly tolerated. Here, we review the current knowledge of the interplay between the immune system and pediatric brain tumors, current clinical trials enrolling patients with pediatric brain tumors, and the challenges unique to this area of research. Early phase clinical trials in pediatric neuro-oncology are plentiful given the rarity of these tumors and efficacy and safety is still to be determined.