Professor Jonathan Finlay | Tackling One of the Rarest Childhood Cancers

CPC develops in the part of the brain that produces cerebrospinal fluid. It grows aggressively, can block fluid pathways, and spreads within the central nervous system. Treatment is gruelling, typically involving major brain surgery, intensive chemotherapy, and sometimes radiation – a therapy that carries serious risks for very young, still-developing brains.

What makes CPC particularly striking is its strong genetic link. Around 60% of young children diagnosed with CPC carry mutations in a gene called TP53, the hallmark of an inherited condition known as Li-Fraumeni syndrome. TP53 is one of the body’s most important cancer-suppressing genes – a kind of molecular guardian that prevents dangerous mutations from accumulating. When it fails, the consequences can be devastating and far-reaching, with affected individuals facing elevated cancer risk throughout their entire lives.

Professor Jonathan Finlay, a paediatric neuro-oncologist at Ohio State University College of Medicine, has dedicated years of his career to confronting this disease. His foundational work involved a large, multi-centre retrospective study – essentially, a careful look back at the outcomes of children already treated for CPC across multiple hospitals internationally. Because the disease is so rare, no single hospital sees enough cases to draw reliable conclusions alone. By pooling data across institutions, meaningful patterns finally began to emerge.

Finlay’s findings were both sobering and instructive. Survival rates in certain groups have historically been poor, but outcomes are far from uniform. Children who undergo complete surgical removal of their tumour tend to fare significantly better. Chemotherapy regimens and genetic status also play important roles in shaping outcomes.

Crucially, the analysis found that for the youngest patients, intensive chemotherapy could serve as an effective alternative to radiation, potentially sparing developing brains from its most harmful long-term effects. The study also revealed that children with Li-Fraumeni syndrome require particularly careful treatment planning, given that radiation therapy may itself trigger future cancers in those carrying TP53 mutations.

Finlay’s retrospective analysis was never intended as an end in itself. It was always a foundation for something bigger – a prospective, risk-stratified, multinational clinical trial that will give children access to standardised, evidence-based treatment regardless of where they live. Motivated in part by the deaths of two young patients whose families pushed for better options, Finlay has spent years assembling the international team, institutional backing, and philanthropic funding needed to make this trial a reality.

For children facing one of medicine’s rarest and most aggressive cancers, this research may represent their best chance at a future.