SHH-activated medulloblastoma: lines of therapy
5 standard-of-care settings across 3 lines and 3 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
Second line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Relapsed, skeletally mature, upstream PTCH1 or SMO lesion | Vismodegib or sonidegib for temporary control; other relapses receive temozolomide-based chemotherapy or re-irradiation. | NCI PDQ: Childhood Medulloblastoma and Other CNS Embryonal Tumors Treatment (health professional version) | 89 |
Special situations
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| HR-positive | Survivorship | Neurocognitive, endocrine and hearing follow-up; skin surveillance for basal cell carcinoma in Gorlin syndrome after radiotherapy. | NCI PDQ: Childhood Medulloblastoma and Other CNS Embryonal Tumors Treatment (health professional version) | - |
Other settings
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| TP53 / del(17p) | Infants under three, TP53-wildtype | HIT-SKK-type chemotherapy with intraventricular methotrexate and no radiotherapy; high-dose chemotherapy with stem cell rescue for poorer methylation subtypes. | NCI PDQ: Childhood Medulloblastoma and Other CNS Embryonal Tumors Treatment (health professional version) | 87 | |
| TP53 / del(17p) | Children over three and adults, TP53-wildtype | Maximal safe resection, craniospinal radiotherapy (23.4 Gy average risk, 36 Gy high risk) with boost, then cisplatin, vincristine and cyclophosphamide or lomustine. | NCI PDQ: Childhood Medulloblastoma and Other CNS Embryonal Tumors Treatment (health professional version) | 93 | |
| TP53 / del(17p) | TP53-mutant | High-risk therapy with germline testing of the child and family; trials of novel agents; radiotherapy weighed against second-tumour risk in Li-Fraumeni syndrome. | NCI PDQ: Childhood Medulloblastoma and Other CNS Embryonal Tumors Treatment (health professional version) | 94 |
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.