Katherine E. Warren, M.D.
Pediatric Oncology Branch
Building 10 - Hatfield CRC, Room 1-5750
Bethesda, MD 20892-1104
Pediatric Neuro-Oncology Section
Pediatric brain tumors represent a heterogeneous group of diseases. A significant proportion of tumors are considered benign or low-grade. The 5-year survival for these children is currently over 70%.
However, for those children with malignant tumors including diffuse intrinsic brainstem gliomas and high-grade gliomas and those with recurrent malignant tumors, the 5-year survival is dismal. Despite neurosurgical and radiotherapeutic advances, no significant improvement in survival has been made for patients suffering from these tumors in several decades.
The armamentarium for the treatment of pediatric central nervous system (CNS) tumors includes surgery, radiation and chemotherapy. Although surgery may be curative for focal, benign tumors, adjuvant therapy is necessary for invasive, malignant lesions. Radiation therapy is toxic to the developing brain and avoided or deferred if possible, in very young children. Although chemotherapy plays an important role, improvement in the survival of pediatric patients with malignant gliomas and recurrent malignant tumors, has been modest, at best, and for some tumors, such as diffuse intrinsic pontine gliomas, no chemotherapy has ever demonstrated an ability to improve patient outcome. Few agents are available for clinical development in children.
In addition to the sometimes disparate tolerability and pharmacokinetics between adult and pediatric patients, pediatric CNS tumors differ from adult CNS tumors in histology, biology, pathophysiology and location, and therefore efficacy data available for adults may not apply to pediatric patients. Rational drug development based on relevant pharmacokinetics (PK), such as CNS penetration, is infrequently performed, and early studies instead frequently aim to identify a maximum tolerated dose rather than a targeted effective dose.
The major goals of the Pediatric Neuro-Oncology Section are rational, PK-based, drug development in the pediatric population, and investigation of novel therapeutic approaches, such as convection-enhanced delivery. Assessing tumor characteristics and treatment effects noninvasively is particularly important in pediatric neuro-oncology given the technical and ethical limitations of repeat tissue sampling in these children. Defining and incorporating innovative endpoints in clinical trials designed to determine the biologic and therapeutic activity of new agents is a major focus of our research.
Dr. Warren received her B.S. in Medical Technology in 1982 and her M.D. from Tufts University School of Medicine in 1990. She completed a residency in pediatrics at Children's National Medical Center, followed by a fellowship in pediatric oncology at the National Cancer Institute. She is board certified in pediatrics and pediatric hematology/oncology. Dr. Warren is a Senior Investigator in the Pediatric Oncology Branch, specializing in neuro-oncology. Her research interests include performance of clinical trials, particularly in children with tumors of the central nervous system, non-invasive evaluation/imaging of the brain, and neurotoxicity resulting from tumors and their treatment.
Baugh J, Bartels U, Leach J, Jones B, Chaney B, Warren KE, Kirkendall J, Doughman R, Hawkins C, Miles L, Fuller C, Hassall T, Bouffet E, Lane A, Hargrave D, Grill J, Hoffman LM, Jones C, Towbin A, Savage SA, Monje M, Li XN, Ziegler DS, Veldhuijzen van Zanten S, Kramm CM, van Vuurden DG, Fouladi M. The international diffuse intrinsic pontine glioma registry: an infrastructure to accelerate collaborative research for an orphan disease. J Neurooncol. 2017;132(2):323-331.
League-Pascual JC, Lester-McCully CM, Shandilya S, Ronner L, Rodgers L, Cruz R, Peer CJ, Figg WD, Warren KE. Plasma and cerebrospinal fluid pharmacokinetics of select chemotherapeutic agents following intranasal delivery in a non-human primate model. J Neurooncol. 2017;132(3):401-407.
Warren KE. Measuring the pons: a non-invasive biomarker for pediatric diffuse intrinsic pontine glioma. CNS Oncol. 2014;3(3):181-3.
Fangusaro J, Warren KE. Unclear standard of care for pediatric high grade glioma patients. J Neurooncol. 2013;113(2):341-2.
Warren KE, Killian K, Suuriniemi M, Wang Y, Quezado M, Meltzer PS. Genomic aberrations in pediatric diffuse intrinsic pontine gliomas. Neuro Oncol. 2012;14(3):326-32.
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This page was last updated on September 13th, 2018