Case Report: Multimodal treatment of pediatric H3G34-mutant diffuse hemispheric glioma: a safety and feasibility case report combining precision medicine and tumor treating fields with conventional care

Diffuse hemispheric glioma, H3G34-mutant (H3G34-DHG) is a rare, highly malignant brain tumour with a dismal prognosis and a median time to progression (TTP) of 10 months with best available practice. We report a case of a 13-year-old boy with H3G34-DHG who underwent a multimodal treatment strategy, combining backbone chemotherapy, radiotherapy, surgery, tumour treating fields with Wilms Tumour-1 (WT1) directed dendritic cell immunotherapy and targeted therapy (STAT3-inhibition). The patient had a TTP of 787 days or 25 months, more than double the literature-reported median, with preserved quality of life and showing downregulation of WT1. This case supports the feasibility of combining multiple therapeutic modalities in the management of high-risk paediatric brain tumours, with potential synergy between different treatment elements. While access to novel therapies in the context of clinical trials remains essential, this case illustrates how treatment can be tailored to individual tumour biology and tolerability. The rationale presented in this detailed case report can inform future trial designs and promote precision medicine approaches for this tumour type.