The dual role of Schlafen11 in brain tumors: Jekyll and Hyde

INTRODUCTION: Schlafen11 (SLFN11) has emerged as a powerful biomarker of sensitivity to DNA-damaging agents in various cancers. However, not much is known about its role in brain tumors. Conflicting reports show that it is a biomarker for response to cisplatin and a prognostic factor in some brain tumors, such as medulloblastomas, but can even be a negative prognostic factor in others, like glioblastomas. AREAS COVERED: In this review, we discuss what is known about the various roles of SLFN11 in cancer, with special attention to brain tumors. Specifically, we focus on the seemingly dual role of SLFN11 in brain tumors; positive prognostic in some and negative in others. Additionally, we describe some glioma cases with high SLFN11 expression, often showing aggressive presentation, a good response to initial treatment, and subsequent widespread relapse. EXPERT OPINION: In brain tumors such as medulloblastomas and primary central nervous system lymphomas (PCNSL), when total cell killing can be expected by chemotherapy and/or chemoradiotherapy, high SLFN11 expression is a positive prognostic marker. However, SLFN11 can also be highly expressed in mesenchymal tumors, and in cases where total cell killing cannot be achieved, widespread relapse can accompany an initial response.