Showing posts with label neuroblastoma treatment. Show all posts
Showing posts with label neuroblastoma treatment. Show all posts
Wednesday, April 4, 2012
Update: Noah
Noah is in New York for 3f8's this week, please keep him in your prayers as we all know how these are.
Friday, November 4, 2011
Neuroblastoma Awareness: Kids with cancer get innovative treatments at new clinic funded by gift to DeVos Children's Hospital
GRAND RAPIDS -- For 8-year-old Ryan Regan, the checkup at the cancer clinic at DeVos Children's Hospital was fun and games.
He laughed when the doctor tickled his belly, showed off a photo of himself in a Superman costume and wandered down the hall to play with friends.
His mother, Cathy Regan, was amazed at how far he had come since he began treatment for neuroblastoma at a pediatric cancer clinic at Helen DeVos Children's Hospital.
"It's a little miracle," said Regan, who lives in Macomb Township in Southeast Michigan.
A grant announced today (Thursday) will provide funding that will allow the clinic to treat more children like Ryan.
The donation of an undisclosed amount of money from Dick and Ethie Haworth establishes the Haworth Family Pediatric Oncology Innovative Therapeutics Clinic, which uses a personalized medicine approach to treating neuroblastoma and other childhood cancers. The director of the clinic, Dr. Giselle Sholler, is also a researcher at Van Andel Institute.
Through the clinic and the institute, the genetic makeup of tumors is analyzed in an effort to determine the best medications to block the cancer. Doctors and researchers in an 11-hospital research consortium are involved in analyzing the test results and choosing the treatment.
Regan said she brought Ryan to the DeVos Children's clinic after doctors at Memorial Sloan-Kettering Cancer Center in New York said they had no more treatment options for him.
Based on the analysis of Ryan's tumor, which formed in his belly and has spread to his liver, Sholler began treating him with three chemotherapy drugs in mid-September. At that point, Ryan weighed only 36 pounds.
"He couldn't walk," his mother said. "He was vomiting. You couldn't pick him up, his liver was so distended. He was on pain meds around the clock."
Ryan's condition improved after the first treatment. In six weeks, he has gained eight pounds -- and lots of energy. One of the goals of the clinic is to use medications with few side effects, so the children can have good quality of life, Sholler said.
That benefit is much appreciated by Regan. Her son has battled cancer for nearly half his life. At 21 months, he was diagnosed with neuroblastoma, a tumor of the peripheral nervous system that typically strikes children 6 and under. The cancer went into remission six months later, but resurfaced when Ryan was 5.
At times, he was treated with high doses of chemotherapy that required three weeks in the hospital for recovery., Regan said.
"We have to drive here, but it's worth it," she said. "His quality of life is awesome."
The clinic is attracting patients from throughout the country and Canada, said Dr. James Fahner, head of pediatric oncology at the hospital. Six children have been treated so far and, eventually, Fahner expects a half-dozen children a week at the clinic.
The clinic's initial focus is on children whose disease has nor responded to therapy, whose cancer has recurred and those whose cancer is so high-risk at diagnosis that standard treatments are not likely to work.
The Haworths said in a statement they made the donation because they believe in the work of the children's cancer program.
"We want to be an encouragement to Dr. Sholler in advancing the science and we look forward to learning about the results of this new initiative," Dick Haworth said.
Source: http://www.mlive.com/news/grand-rapids/index.ssf/2011/11/kids_with_cancer_get_innovativ.html
Thursday, October 20, 2011
Neuroblastoma Awareness: ALK gene discovered by St. Jude scientists associated with FDA approved adult cancer drug
A drug recently approved by the U.S. Food and Drug Administration for treatment of an adult cancer targets a malfunctioning gene discovered more than a decade earlier at St. Jude Children's Research Hospital. The story highlights how scientific findings from St. Jude can be translated into therapies and tests that in addition to helping children, also help adults.
The drug is Xalkori (crizotinib). The FDA approved Xalkori in August as the first targeted therapy for patients with ALK-positive non-small cell lung cancer (NSCLC) that is locally advanced or metastatic. Xalkori is manufactured by the pharmaceutical company Pfizer.
The ALK gene was discovered by St. Jude scientists searching for genes affected by a chromosomal change common in the cancer cells of patients with anaplastic large cell lymphoma (ALCL).The blood cancer accounts for 10 to 30 percent of pediatric non-Hodgkin lymphoma. In 1994 Stephan Morris, M.D., then a St. Jude junior faculty member; Thomas Look, M.D., then chair of a St. Jude department; and their colleagues, published the first of several reports detailing the discovery of ALK and the gene's pivotal role in driving the cancer. ALK is short for anaplastic lymphoma kinase, the name investigators gave the protein whose assembly instructions the gene carried.
ALK is now widely recognized as a potent promoter of several adult and childhood cancers, including ALCL and neuroblastoma, a childhood tumor of certain nerve cells. The work done by Morris, Look and their colleagues in a fifth-floor laboratory of the Danny Thomas Research Center eventually helped to launch a new targeted cancer treatment.
Hiroyuki Mano, M.D., of the University of Tokyo, led the 2007 research into the molecular drivers of NSCLC. The study showed some NSCLC tumors were driven by an ALK rearrangement. Following this discovery, Pfizer expanded a Phase I clinical trial of Xalkori to include patients with ALK-positive advanced NSCLC. Xalkori blocks the cancer-causing activity of the ALK protein. Additional clinical trials with the drug are now underway in other cancers, including neuroblastoma and ALCL, the lymphoma that launched the search.
The ALK discovery and related later research led to five U.S. patents for St. Jude. The patented work includes methods for detecting the chromosomal rearrangements that unleash the cancer-causing ability of the ALK gene as well as tools to identify and characterize drugs for cancers caused by ALK deregulation. Morris, Look and their colleagues also worked with another pharmaceutical company to design a diagnostic assay to identify patients with the ALK mutation. The test, a fluorescence in situ hybridization (FISH) assay, has been marketed for more than a decade. In August, it won FDA approval as a diagnostic test for use with Xalkori.
Dr. William E. Evans, St. Jude director and chief executive officer, said the ALK story captures an important aspect of the hospital's commitment. "Our focus is on finding cures for pediatric diseases, but our discoveries often provide insights that can be building blocks for advances in other diseases, including adult cancers. We are committed to facilitating this so that the most good can come from our discoveries," he said.
Working through the St. Jude Office of Technology Licensing, Pfizer obtained licenses to the hospital's patented research tools. Several other companies have executed licenses with St. Jude to use these patent rights.
This year about 210,000 new cases of lung cancer will be diagnosed in the U.S. Current estimates are that approximately 3 to 5 percent, or 6,500 to 11,000 patients with non-small cell lung cancer, carry the ALK rearrangement and may be candidates for treatment with Xalkori.
Today, Morris is a member of the St. Jude Pathology and Oncology departments. Look is a professor of pediatrics at Harvard Medical School and the Dana-Farber Cancer Center in Boston. Morris is still asking questions about ALK, including the protein's normal functions. He said he is thrilled that his work offers new hope for thousands of lung cancer patients. "We knew in 1994 when we initially discovered ALK that it was an outstanding drug-development target," Morris said. "It is heartening to now see patients benefiting from our research."
Source St. Jude Children's Research Hospital
Source: http://www.news-medical.net/news/20110930/ALK-gene-discovered-by-St-Jude-scientists-associated-with-FDA-approved-adult-cancer-drug.aspx
The drug is Xalkori (crizotinib). The FDA approved Xalkori in August as the first targeted therapy for patients with ALK-positive non-small cell lung cancer (NSCLC) that is locally advanced or metastatic. Xalkori is manufactured by the pharmaceutical company Pfizer.
The ALK gene was discovered by St. Jude scientists searching for genes affected by a chromosomal change common in the cancer cells of patients with anaplastic large cell lymphoma (ALCL).The blood cancer accounts for 10 to 30 percent of pediatric non-Hodgkin lymphoma. In 1994 Stephan Morris, M.D., then a St. Jude junior faculty member; Thomas Look, M.D., then chair of a St. Jude department; and their colleagues, published the first of several reports detailing the discovery of ALK and the gene's pivotal role in driving the cancer. ALK is short for anaplastic lymphoma kinase, the name investigators gave the protein whose assembly instructions the gene carried.
ALK is now widely recognized as a potent promoter of several adult and childhood cancers, including ALCL and neuroblastoma, a childhood tumor of certain nerve cells. The work done by Morris, Look and their colleagues in a fifth-floor laboratory of the Danny Thomas Research Center eventually helped to launch a new targeted cancer treatment.
Hiroyuki Mano, M.D., of the University of Tokyo, led the 2007 research into the molecular drivers of NSCLC. The study showed some NSCLC tumors were driven by an ALK rearrangement. Following this discovery, Pfizer expanded a Phase I clinical trial of Xalkori to include patients with ALK-positive advanced NSCLC. Xalkori blocks the cancer-causing activity of the ALK protein. Additional clinical trials with the drug are now underway in other cancers, including neuroblastoma and ALCL, the lymphoma that launched the search.
The ALK discovery and related later research led to five U.S. patents for St. Jude. The patented work includes methods for detecting the chromosomal rearrangements that unleash the cancer-causing ability of the ALK gene as well as tools to identify and characterize drugs for cancers caused by ALK deregulation. Morris, Look and their colleagues also worked with another pharmaceutical company to design a diagnostic assay to identify patients with the ALK mutation. The test, a fluorescence in situ hybridization (FISH) assay, has been marketed for more than a decade. In August, it won FDA approval as a diagnostic test for use with Xalkori.
Dr. William E. Evans, St. Jude director and chief executive officer, said the ALK story captures an important aspect of the hospital's commitment. "Our focus is on finding cures for pediatric diseases, but our discoveries often provide insights that can be building blocks for advances in other diseases, including adult cancers. We are committed to facilitating this so that the most good can come from our discoveries," he said.
Working through the St. Jude Office of Technology Licensing, Pfizer obtained licenses to the hospital's patented research tools. Several other companies have executed licenses with St. Jude to use these patent rights.
This year about 210,000 new cases of lung cancer will be diagnosed in the U.S. Current estimates are that approximately 3 to 5 percent, or 6,500 to 11,000 patients with non-small cell lung cancer, carry the ALK rearrangement and may be candidates for treatment with Xalkori.
Today, Morris is a member of the St. Jude Pathology and Oncology departments. Look is a professor of pediatrics at Harvard Medical School and the Dana-Farber Cancer Center in Boston. Morris is still asking questions about ALK, including the protein's normal functions. He said he is thrilled that his work offers new hope for thousands of lung cancer patients. "We knew in 1994 when we initially discovered ALK that it was an outstanding drug-development target," Morris said. "It is heartening to now see patients benefiting from our research."
Source St. Jude Children's Research Hospital
Source: http://www.news-medical.net/news/20110930/ALK-gene-discovered-by-St-Jude-scientists-associated-with-FDA-approved-adult-cancer-drug.aspx
Wednesday, September 14, 2011
Progesterone could fight against neuroblastoma
High doses of the hormone progesterone can kill neuroblastoma cells while leaving healthy cells unscathed, scientists at Emory University School of Medicine have found in laboratory research.
The results, published in the journal Molecular Medicine, suggest that progesterone could be used to fight neuroblastoma, the most common form of cancer affecting small children.
More research is necessary to determine the optimal dose, how long progesterone treatment should last and if it should be used alone or in combination with radiation or chemotherapy. Emory scientists are also exploring whether it can stop the growth of other brain cancer types such as glioblastoma and astrocytoma. Progesterone has also been reported to slow growth of several other types of cancers in the laboratory, but has not been used clinically against neuroblastoma.
The first author in the team of researchers is Fahim Atif, PhD, instructor in emergency medicine, with senior author Donald G. Stein, PhD, Asa G. Candler professor of emergency medicine and director of Emory's Department of Emergency Medicine Brain Research Laboratory. Daniel Brat, MD, PhD, professor of pathology and laboratory medicine in Emory School of Medicine was a collaborator on the research team.
The discovery grew out of studies of progesterone's protective effects in brain injury. Based on Stein's pioneering work, medical centers across the country are now testing progesterone in the setting of acute traumatic brain injury in a phase III clinical trial. While investigating how to enhance progesterone's effectiveness, Atif and his colleagues observed that it could protect healthy neurons from stress but caused cells from a tumor cell line to die.
In a mouse model, progesterone treatment cut tumor growth in half over eight days, while no drug toxicity was seen with healthy neurons or in live animals. The researchers showed that progesterone can decrease the levels of proteins produced by tumor cells that attract new blood vessel growth and help tumor cells invade other tissues.
"This fits with what we know about one of progesterone's roles during pregnancy, which is to regulate the growth of placenta," Atif says. "Placental cells behave in a way that resembles tumor cells, invading the uterine wall and tapping into the mother's blood vessels."
In studies performed elsewhere, doses of progesterone that were lower than the most effective dose in the Emory study actually accelerated cancer growth. Based on their results, the Emory researchers propose that for fighting certain types of cancer, high doses of progesterone may be better than low doses.
Progesterone's effects on cancer are known to be complex. There may be differences between progesterone, the natural hormone, and synthetic progestins. The National Institutes of Health's Women's Health Initiative study showed that women who received hormone replacement therapy with combined estrogen and progestins had an increased risk of heart disease and breast cancer, although some studies have identified a potential "safe period" if hormone replacement therapy lasts less than two years.
Progesterone has a long history as a treatment designed to prevent preterm birth. If progesterone is to be used with small children, any potential effects on development must be weighed against the risks of standard treatments.
Source: Emory University
Source:http://www.news-medical.net/news/20110714/Progesterone-could-fight-against-neuroblastoma.aspx?page=2
The results, published in the journal Molecular Medicine, suggest that progesterone could be used to fight neuroblastoma, the most common form of cancer affecting small children.
More research is necessary to determine the optimal dose, how long progesterone treatment should last and if it should be used alone or in combination with radiation or chemotherapy. Emory scientists are also exploring whether it can stop the growth of other brain cancer types such as glioblastoma and astrocytoma. Progesterone has also been reported to slow growth of several other types of cancers in the laboratory, but has not been used clinically against neuroblastoma.
The first author in the team of researchers is Fahim Atif, PhD, instructor in emergency medicine, with senior author Donald G. Stein, PhD, Asa G. Candler professor of emergency medicine and director of Emory's Department of Emergency Medicine Brain Research Laboratory. Daniel Brat, MD, PhD, professor of pathology and laboratory medicine in Emory School of Medicine was a collaborator on the research team.
The discovery grew out of studies of progesterone's protective effects in brain injury. Based on Stein's pioneering work, medical centers across the country are now testing progesterone in the setting of acute traumatic brain injury in a phase III clinical trial. While investigating how to enhance progesterone's effectiveness, Atif and his colleagues observed that it could protect healthy neurons from stress but caused cells from a tumor cell line to die.
In a mouse model, progesterone treatment cut tumor growth in half over eight days, while no drug toxicity was seen with healthy neurons or in live animals. The researchers showed that progesterone can decrease the levels of proteins produced by tumor cells that attract new blood vessel growth and help tumor cells invade other tissues.
"This fits with what we know about one of progesterone's roles during pregnancy, which is to regulate the growth of placenta," Atif says. "Placental cells behave in a way that resembles tumor cells, invading the uterine wall and tapping into the mother's blood vessels."
In studies performed elsewhere, doses of progesterone that were lower than the most effective dose in the Emory study actually accelerated cancer growth. Based on their results, the Emory researchers propose that for fighting certain types of cancer, high doses of progesterone may be better than low doses.
Progesterone's effects on cancer are known to be complex. There may be differences between progesterone, the natural hormone, and synthetic progestins. The National Institutes of Health's Women's Health Initiative study showed that women who received hormone replacement therapy with combined estrogen and progestins had an increased risk of heart disease and breast cancer, although some studies have identified a potential "safe period" if hormone replacement therapy lasts less than two years.
Progesterone has a long history as a treatment designed to prevent preterm birth. If progesterone is to be used with small children, any potential effects on development must be weighed against the risks of standard treatments.
Source: Emory University
Source:http://www.news-medical.net/news/20110714/Progesterone-could-fight-against-neuroblastoma.aspx?page=2
Sunday, August 7, 2011
Neuroblastoma Awareness: Trial Drug helps children with deadly Neuroblastoma Cancer
An experimental drug, available only through a clinical trial, helps prevent relapses in children with a rare cancer called neuroblastoma.
Children with high-risk neuroblastoma, which grows in nerve cells in the neck, chest and abdomen, desperately need better treatments, experts say.
CANCER: More concerns raised over formaldehyde
STUDY: Ginger relieves chemo nausea
FORUM: Living with Cancer
A new, man-made antibody may save some of them, says Alice Yu, a professor at the Moores University of California-San Diego Cancer Center.
In a study of 226 children, Yu found that combining the antibody with other immune therapies cuts the risk of relapse by 20%.
Two years after getting the new therapy, 66% of kids were relapse-free, compared to 46% of kids randomly assigned to receive a standard therapy called retinoic acid, according to a study released Thursday, in advance of the annual meeting of the American Society of Clinical Oncology, which begins in two weeks in Orlando.
Because most relapses occur in the first two years after a bone marrow transplant, Yu says these kids are likely to have been cured. About 86% of those who got the antibody were alive after two years, compared to 75% who got standard therapy.
That's a big improvement for such a stubborn disease, says Nai-Kong Cheung, head of the neuroblastoma program at New York's Memorial Sloan-Kettering Cancer Center, who was not involved in the new study. Neuroblastoma causes 15% of all deaths from pediatric cancer.
Cheung says the study is a "landmark," not only because the drug seems so helpful, but because of the difficulty of conducting a definitive trial in a disease with so few patients.
"This is a major, major event," says Cheung, who says this is the first new therapy for high-risk neuroblastoma in about 10 years.
Most children with the disease are toddlers under age 5. About 40% of the 650 kids diagnosed each year have aggressive tumors. Of those, only about 30% survive, in spite of intense and painful therapies, that include surgery, heavy chemotherapy, radiation and bone marrow transplants.
"We basically throw the book at them," Yu says.
Now, antibody therapy will become the new standard of care, she says.
Yet Cheung notes that doctors will have to wait many years to know if children were truly cured. And he notes that the antibody therapy is not easy to take.
More than 20% of children treated with the antibody suffered significant pain during the five to 10 hours that it takes to receive the intravenous drug, Yu says. Children receive the drug four days a month for five months.
About 7% of children also developed leaky blood vessels and another 7% developed allergic reactions, the study shows.
"It's a very tough treatment," Yu says. "But if we can achieve a cure for another 20% of kids, then it's worth it."
Older therapies pose their own risks. The heavy chemo that children receive early on their therapy can damage the heart and kidneys and even cause sterility or new cancers, Cheung says.
Cheung notes that doctors have been trying to spare as many children as possible from these toxic side effects, even as they struggle to save them from an aggressive disease. Doctors now try to reserve the harshest therapies for children with genetic markers indicating their tumors put them at high risk, he says. Children with low-risk neuroblastoma get a lighter type of chemotherapy, which causes fewer long-term side effects, Cheung says.
Families who are interested in the antibody for their children can still join the study, Yu says. Researchers will continue to monitor the drug's safety in order to apply for approval with the Food and Drug Administration, Yu says.
Yet the drug's future remains uncertain.
Cancers such as neuroblastoma are considered "orphan" diseases, because drugmakers are reluctant to invest heavily in such a small market, Cheung says. The National Cancer Institute provided the antibodies used in the trial because there were no drug companies willing to manufacture it. Although several companies have shown interest in the drug, none have yet committed to making it, Yu says."Now that we've discovered that this drug is useful, it's cruel not to be able to give it to someone," Cheung says. "Someone will have to maintain the supply."
http://www.usatoday.com/news/health/2009-05-14-neuroblastoma-cancer_N.htm
Children with high-risk neuroblastoma, which grows in nerve cells in the neck, chest and abdomen, desperately need better treatments, experts say.
CANCER: More concerns raised over formaldehyde
STUDY: Ginger relieves chemo nausea
FORUM: Living with Cancer
A new, man-made antibody may save some of them, says Alice Yu, a professor at the Moores University of California-San Diego Cancer Center.
In a study of 226 children, Yu found that combining the antibody with other immune therapies cuts the risk of relapse by 20%.
Two years after getting the new therapy, 66% of kids were relapse-free, compared to 46% of kids randomly assigned to receive a standard therapy called retinoic acid, according to a study released Thursday, in advance of the annual meeting of the American Society of Clinical Oncology, which begins in two weeks in Orlando.
Because most relapses occur in the first two years after a bone marrow transplant, Yu says these kids are likely to have been cured. About 86% of those who got the antibody were alive after two years, compared to 75% who got standard therapy.
That's a big improvement for such a stubborn disease, says Nai-Kong Cheung, head of the neuroblastoma program at New York's Memorial Sloan-Kettering Cancer Center, who was not involved in the new study. Neuroblastoma causes 15% of all deaths from pediatric cancer.
Cheung says the study is a "landmark," not only because the drug seems so helpful, but because of the difficulty of conducting a definitive trial in a disease with so few patients.
"This is a major, major event," says Cheung, who says this is the first new therapy for high-risk neuroblastoma in about 10 years.
Most children with the disease are toddlers under age 5. About 40% of the 650 kids diagnosed each year have aggressive tumors. Of those, only about 30% survive, in spite of intense and painful therapies, that include surgery, heavy chemotherapy, radiation and bone marrow transplants.
"We basically throw the book at them," Yu says.
Now, antibody therapy will become the new standard of care, she says.
Yet Cheung notes that doctors will have to wait many years to know if children were truly cured. And he notes that the antibody therapy is not easy to take.
More than 20% of children treated with the antibody suffered significant pain during the five to 10 hours that it takes to receive the intravenous drug, Yu says. Children receive the drug four days a month for five months.
About 7% of children also developed leaky blood vessels and another 7% developed allergic reactions, the study shows.
"It's a very tough treatment," Yu says. "But if we can achieve a cure for another 20% of kids, then it's worth it."
Older therapies pose their own risks. The heavy chemo that children receive early on their therapy can damage the heart and kidneys and even cause sterility or new cancers, Cheung says.
Cheung notes that doctors have been trying to spare as many children as possible from these toxic side effects, even as they struggle to save them from an aggressive disease. Doctors now try to reserve the harshest therapies for children with genetic markers indicating their tumors put them at high risk, he says. Children with low-risk neuroblastoma get a lighter type of chemotherapy, which causes fewer long-term side effects, Cheung says.
Families who are interested in the antibody for their children can still join the study, Yu says. Researchers will continue to monitor the drug's safety in order to apply for approval with the Food and Drug Administration, Yu says.
Yet the drug's future remains uncertain.
Cancers such as neuroblastoma are considered "orphan" diseases, because drugmakers are reluctant to invest heavily in such a small market, Cheung says. The National Cancer Institute provided the antibodies used in the trial because there were no drug companies willing to manufacture it. Although several companies have shown interest in the drug, none have yet committed to making it, Yu says."Now that we've discovered that this drug is useful, it's cruel not to be able to give it to someone," Cheung says. "Someone will have to maintain the supply."
http://www.usatoday.com/news/health/2009-05-14-neuroblastoma-cancer_N.htm
Wednesday, July 27, 2011
Neuroblastoma Treatments: Molecular radiotherapy offers hope for children with neuroblastoma
http://www.news-medical.net/news/20110630/Molecular-radiotherapy-offers-hope-for-children-with-neuroblastoma.aspx
A new treatment option may soon be available for children with neuroblastoma according to research published in the July issue of The Journal of Nuclear Medicine. The study tested the principle that combined positron emission tomography and X-ray computed tomography (PET/CT) may be used to select children with primary refractory or relapsed high-risk neuroblastoma for treatment with a molecular radiotherapy known as 177Lu-DOTATATE. This therapeutic option was found to be viable option for children with neuroblastomas.
Neuroblastoma is a cancerous tumor that develops from nerve tissue in infants and children. Accounting for six to 10 percent of all childhood cancers, it does not always follow the same pattern, with some patients regressing spontaneously and other progressing, despite aggressive therapy. The long-term survival rate for neuroblastoma is below 40 percent.
"We know that peptide receptor radionuclide therapy in adults with somatostatin-positive neuroendocrine tumors has resulted in improved symptoms, prolonged survival and an enhanced quality of life. Since some neuroblastomas express somatostatin receptors, we felt this approach could be beneficial to children as well," said Jamshed B. Bomanji, MBBS, PhD, FRCR, FRCP, one of the authors of the study "177Lu-DOTATATE Molecular Radiotherapy for Childhood Neuroblastoma."
In the study, eight children with relapsed or primary refractory neuroblastoma were imaged with a 68Ga-DOTATATE PET/CT scan. If the disease sites showed 68Ga-DOTATATE uptake greater than the liver, the child was considered eligible for the molecular radiotherapy. Therapy with 177Lu-DOTATATE was determined to be suitable for six of the children and was administered appropriately.
After completing treatment with 177Lu-DOTATATE, five children had stable disease by the response evaluation criteria in solid tumors. The treatment was feasible, practical and well-tolerated in the small group of patients with high-risk neuroblastoma. As a result, the researchers plan to evaluate 177Lu-DOTATATE formally in a phase I-II clinical trial to evaluate toxicity and response.
"Molecular imaging has contributed a new diagnostic technique to map the full extent of disease. This mode of treatment has great potential for children whose treatment options are limited, as neuroblastoma often becomes resistant to chemotherapy and success is limited by poor bone marrow reserve," noted Bomanji.
sources: http://www.news-medical.net/news/20110630/Molecular-radiotherapy-offers-hope-for-children-with-neuroblastoma.aspx
A new treatment option may soon be available for children with neuroblastoma according to research published in the July issue of The Journal of Nuclear Medicine. The study tested the principle that combined positron emission tomography and X-ray computed tomography (PET/CT) may be used to select children with primary refractory or relapsed high-risk neuroblastoma for treatment with a molecular radiotherapy known as 177Lu-DOTATATE. This therapeutic option was found to be viable option for children with neuroblastomas.
Neuroblastoma is a cancerous tumor that develops from nerve tissue in infants and children. Accounting for six to 10 percent of all childhood cancers, it does not always follow the same pattern, with some patients regressing spontaneously and other progressing, despite aggressive therapy. The long-term survival rate for neuroblastoma is below 40 percent.
"We know that peptide receptor radionuclide therapy in adults with somatostatin-positive neuroendocrine tumors has resulted in improved symptoms, prolonged survival and an enhanced quality of life. Since some neuroblastomas express somatostatin receptors, we felt this approach could be beneficial to children as well," said Jamshed B. Bomanji, MBBS, PhD, FRCR, FRCP, one of the authors of the study "177Lu-DOTATATE Molecular Radiotherapy for Childhood Neuroblastoma."
In the study, eight children with relapsed or primary refractory neuroblastoma were imaged with a 68Ga-DOTATATE PET/CT scan. If the disease sites showed 68Ga-DOTATATE uptake greater than the liver, the child was considered eligible for the molecular radiotherapy. Therapy with 177Lu-DOTATATE was determined to be suitable for six of the children and was administered appropriately.
After completing treatment with 177Lu-DOTATATE, five children had stable disease by the response evaluation criteria in solid tumors. The treatment was feasible, practical and well-tolerated in the small group of patients with high-risk neuroblastoma. As a result, the researchers plan to evaluate 177Lu-DOTATATE formally in a phase I-II clinical trial to evaluate toxicity and response.
"Molecular imaging has contributed a new diagnostic technique to map the full extent of disease. This mode of treatment has great potential for children whose treatment options are limited, as neuroblastoma often becomes resistant to chemotherapy and success is limited by poor bone marrow reserve," noted Bomanji.
sources: http://www.news-medical.net/news/20110630/Molecular-radiotherapy-offers-hope-for-children-with-neuroblastoma.aspx
Sunday, July 24, 2011
Tuesday, July 19, 2011
Neuroblastoma Treatments:Fatty Oil may be next treatment for cancer
DHA (docosahexaenoic acid), an omega-3 fatty acid found in cold water fatty fish and fish oil supplements, may be the next treatment for cancer. A new study shows that DHA and its derivatives have the ability to kill neuroblastoma cancer cells.
DHA is essential for the proper functioning of the adult brain and for the development of the nervous system and vision during the first six months of life. Along with eicosapentaenoic acid (EPA), the other main omega-3 fatty acid in cold water fatty fish, DHA helps lower the risk of heart disease. Although humans naturally produce small amounts of DHA, people must get the DHA they need from diet or supplements. The University of Maryland Medical Center notes that most people in the Western world do not get an adequate amount of omega-3 fatty acids from their diet.
Researchers with the new study, which was conducted at the Karolinska Institutet in Stockholm, Sweden, administered DHA to neuroblastoma cells from the nervous system and analyzed them for byproducts as the DHA broke down. They then examined the impact of both DHA and its derivatives on the growth of cancer cells. They discovered that DHA killed the cancer cells, and that the derivatives were even more effective at destroying cancer.
Helena Gleissman, PhD, co-author of the study from the Childhood Cancer Research Unit of the Karolinska Institutet, notes that “Ultimately, we hope that we can be able to cure more children with neuroblastoma, and possibly other cancers,” including medulloblastoma, colon, breast, and prostate cancers, among others.
Neuroblastoma is a cancer that often begins in early childhood, according to the National Institutes of Health. This form of cancer develops in the nerve tissues and usually begins in the adrenal glands, although it can also start in the neck, chest, or spinal cord. It can even begin before a child is born. Physicians usually do not find the cancer until it has spread to other parts of the body.
Results of the new study are “good news for those looking to stop cancer,” says Gerald Weissmann, MD, editor-in-chief of The FASEB Journal. Until now, researchers have known that DHA has the ability to prevent and treat various diseases. “Now we see that DHA or one of its byproducts might serve as the starting point for a new class of anti-cancer drugs,” notes Weissman.
SOURCES:
Gleissman H et al. The FASEB Journal 2010; 24(3)
National Institutes of Health
University of Maryland Medical Center
http://www.emaxhealth.com/1275/51/35890/dha-may-be-new-treatment-cancer.html
DHA is essential for the proper functioning of the adult brain and for the development of the nervous system and vision during the first six months of life. Along with eicosapentaenoic acid (EPA), the other main omega-3 fatty acid in cold water fatty fish, DHA helps lower the risk of heart disease. Although humans naturally produce small amounts of DHA, people must get the DHA they need from diet or supplements. The University of Maryland Medical Center notes that most people in the Western world do not get an adequate amount of omega-3 fatty acids from their diet.
Researchers with the new study, which was conducted at the Karolinska Institutet in Stockholm, Sweden, administered DHA to neuroblastoma cells from the nervous system and analyzed them for byproducts as the DHA broke down. They then examined the impact of both DHA and its derivatives on the growth of cancer cells. They discovered that DHA killed the cancer cells, and that the derivatives were even more effective at destroying cancer.
Helena Gleissman, PhD, co-author of the study from the Childhood Cancer Research Unit of the Karolinska Institutet, notes that “Ultimately, we hope that we can be able to cure more children with neuroblastoma, and possibly other cancers,” including medulloblastoma, colon, breast, and prostate cancers, among others.
Neuroblastoma is a cancer that often begins in early childhood, according to the National Institutes of Health. This form of cancer develops in the nerve tissues and usually begins in the adrenal glands, although it can also start in the neck, chest, or spinal cord. It can even begin before a child is born. Physicians usually do not find the cancer until it has spread to other parts of the body.
Results of the new study are “good news for those looking to stop cancer,” says Gerald Weissmann, MD, editor-in-chief of The FASEB Journal. Until now, researchers have known that DHA has the ability to prevent and treat various diseases. “Now we see that DHA or one of its byproducts might serve as the starting point for a new class of anti-cancer drugs,” notes Weissman.
SOURCES:
Gleissman H et al. The FASEB Journal 2010; 24(3)
National Institutes of Health
University of Maryland Medical Center
http://www.emaxhealth.com/1275/51/35890/dha-may-be-new-treatment-cancer.html
Wednesday, October 13, 2010
Yesterday
I surpassed my goal of getting 30 visitors to www.neuroblastomaawareness.com and got 8 more then my goal was! Keep it up! My next goal is for 50 a day! Today we've only had 3 but I posted in the post below information about neuroblastoma and pesticides effects. It is a journal article so you may need a membership or I can email you a copy of it.
God bless all those with, fighting or who have lost their battle with neuroblastoma
God bless all those with, fighting or who have lost their battle with neuroblastoma
Monday, October 11, 2010
Stages of Neuroblastoma
After neuroblastoma has been diagnosed, tests are done to find out if cancer has spread from where it started to other parts of the body.
The process used to find out the extent or spread of cancer is called staging. The information gathered from the staging process helps determine the stage of the disease. For neuroblastoma, stage is one of the factors used to plan treatment. The following tests and procedures may be used to determine the stage:
Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
Lymph nodebiopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells. One of the following types of biopsies may be done:
Excisional biopsy: The removal of an entire lymph node.
Incisional biopsy: The removal of part of a lymph node.
Core biopsy: The removal of tissue from a lymph node using a wide needle.
Fine-needle aspiration (FNA) biopsy: The removal of tissue or fluid from a lymph node using a thin needle.
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
X-rays of the chest, bones, and abdomen: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
Radionuclide scan: A procedure to find areas in the body where cells, such as cancer cells, are dividing rapidly. A very small amount of radioactive material is swallowed or injected into a vein and travels through the bloodstream. The radioactive material collects in the bones or other tissues and is detected by a radiation-measuring device.
There are three ways that cancer spreads in the body.
Through tissue. Cancer invades the surrounding normal tissue.
Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are used for neuroblastoma:
Stage 1
In stage 1, the tumor is in only one area and all of the tumor that can be seen is completely removed during surgery.
Stage 2
Stage 2 is divided into stage 2A and 2B.
Stage 2A: The tumor is in only one area and all of the tumor that can be seen cannot be completely removed during surgery.
Stage 2B: The tumor is in only one area and all of the tumor that can be seen may be completely removed during surgery. Cancercells are found in the lymph nodes near the tumor.
Stage 3
In stage 3, one of the following is true:
the tumor cannot be completely removed during surgery and has spread from one side of the body to the other side and may also have spread to nearby lymph nodes; or
the tumor is in only one area, on one side of the body, but has spread to lymph nodes on the other side of the body; or
the tumor is in the middle of the body and has spread to tissues or lymph nodes on both sides of the body, and the tumor cannot be removed by surgery.
Stage 4
Stage 4 is divided into stage 4 and stage 4S.
In stage 4, the tumor has spread to distant lymph nodes, the skin, or other parts of the body.
In stage 4S, the following are true:
the child is younger than 1 year; and
the cancer has spread to the skin, liver, and/or bone marrow; and
the tumor is in only one area and all of the tumor that can be seen may be completely removed during surgery; and/or
cancer cells may be found in the lymph nodes near the tumor.
Treatment of neuroblastoma is based on risk groups.
For many types of cancer, stages are used to plan treatment. For neuroblastoma, treatment depends on risk groups. The stage of neuroblastoma is one factor used to determine risk group. Other factors are the age of the child, tumor histology, and tumor biology.
There are 3 risk groups: low risk, intermediate risk, and high risk.
Low-risk and intermediate-risk neuroblastoma have a good chance of being cured.
High-risk neuroblastoma may be difficult to cure.
sources:http://www.webmd.com/cancer/tc/neuroblastoma-treatment-patient-information-nci-pdq-stages-of-neuroblastoma
The process used to find out the extent or spread of cancer is called staging. The information gathered from the staging process helps determine the stage of the disease. For neuroblastoma, stage is one of the factors used to plan treatment. The following tests and procedures may be used to determine the stage:
Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
Lymph nodebiopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells. One of the following types of biopsies may be done:
Excisional biopsy: The removal of an entire lymph node.
Incisional biopsy: The removal of part of a lymph node.
Core biopsy: The removal of tissue from a lymph node using a wide needle.
Fine-needle aspiration (FNA) biopsy: The removal of tissue or fluid from a lymph node using a thin needle.
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
X-rays of the chest, bones, and abdomen: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
Radionuclide scan: A procedure to find areas in the body where cells, such as cancer cells, are dividing rapidly. A very small amount of radioactive material is swallowed or injected into a vein and travels through the bloodstream. The radioactive material collects in the bones or other tissues and is detected by a radiation-measuring device.
There are three ways that cancer spreads in the body.
Through tissue. Cancer invades the surrounding normal tissue.
Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are used for neuroblastoma:
Stage 1
In stage 1, the tumor is in only one area and all of the tumor that can be seen is completely removed during surgery.
Stage 2
Stage 2 is divided into stage 2A and 2B.
Stage 2A: The tumor is in only one area and all of the tumor that can be seen cannot be completely removed during surgery.
Stage 2B: The tumor is in only one area and all of the tumor that can be seen may be completely removed during surgery. Cancercells are found in the lymph nodes near the tumor.
Stage 3
In stage 3, one of the following is true:
the tumor cannot be completely removed during surgery and has spread from one side of the body to the other side and may also have spread to nearby lymph nodes; or
the tumor is in only one area, on one side of the body, but has spread to lymph nodes on the other side of the body; or
the tumor is in the middle of the body and has spread to tissues or lymph nodes on both sides of the body, and the tumor cannot be removed by surgery.
Stage 4
Stage 4 is divided into stage 4 and stage 4S.
In stage 4, the tumor has spread to distant lymph nodes, the skin, or other parts of the body.
In stage 4S, the following are true:
the child is younger than 1 year; and
the cancer has spread to the skin, liver, and/or bone marrow; and
the tumor is in only one area and all of the tumor that can be seen may be completely removed during surgery; and/or
cancer cells may be found in the lymph nodes near the tumor.
Treatment of neuroblastoma is based on risk groups.
For many types of cancer, stages are used to plan treatment. For neuroblastoma, treatment depends on risk groups. The stage of neuroblastoma is one factor used to determine risk group. Other factors are the age of the child, tumor histology, and tumor biology.
There are 3 risk groups: low risk, intermediate risk, and high risk.
Low-risk and intermediate-risk neuroblastoma have a good chance of being cured.
High-risk neuroblastoma may be difficult to cure.
sources:http://www.webmd.com/cancer/tc/neuroblastoma-treatment-patient-information-nci-pdq-stages-of-neuroblastoma
Sunday, October 10, 2010
Less-Intense Chemo Effective in Children with Intermediate-Risk Neuroblastoma
Infants and children with intermediate-risk neuroblastoma who received a less-intensive chemotherapy regimen had three-year overall survival rates as good as those patients in an earlier trial who received treatment that was more intensive and more toxic
Background
Neuroblastoma, the fourth most common solid tumor in children under the age of 16, begins in immature nerve cells, most often in the adrenal gland, neck, chest, or spinal cord. Neuroblastoma is classified as low, intermediate, or high risk of disease recurrence after treatment, based on factors such as the patient’s age, how far the disease has spread (metastasized), and what genetic mutations are found in the tumor.
For neuroblastoma tumors that have already spread within a limited region at the time of diagnosis, doctors can use a combination of surgery and chemotherapy to kill both the original tumor and cancer cells elsewhere. For children with intermediate-risk neuroblastoma, this treatment approach is very effective at preventing the cancer from returning and also increases survival.
However, while effective, this approach requires many months to complete and causes potentially serious side effects, including damage to the kidneys, heart, and hearing as well as a temporary decrease in white blood cells that can expose the patient to dangerous infections.
The clinical trial described below examined whether a shorter, less-intense course of chemotherapy could be as effective in preventing disease recurrence and extending survival as more-intense regimens in children with intermediate-risk neuroblastoma.
The Study
Between March 1997 and May 2005, this single-arm phase III clinical trial (called A3961) enrolled 467 eligible patients with intermediate-risk neuroblastoma from participating hospitals in Australia, New Zealand, and North America. The study used historical patient controls. That is, the investigators compared the results from the A3961 trial to an earlier study (called CCG 3881) performed by the Children’s Cancer Group among a similar population of neuroblastoma patients who had received a more-intense chemotherapy regimen between 1989 and 1996.
All participants in the A3961 trial underwent initial surgery, and were divided into two groups based on the relative likelihood of tumor recurrence—a ‘favorable’ prognosis group and an ‘unfavorable’ prognosis group.
Infants and children in the favorable-prognosis group were scheduled to receive four cycles of chemotherapy, and those in the unfavorable-prognosis group were scheduled to receive eight cycles. If a patient in the favorable-prognosis group did not experience a satisfactory tumor response to the initial treatment, the patient could receive the full eight cycles of chemotherapy. The cycles consisted of different combinations of the drugs carboplatin, etoposide, cyclophosphamide, and doxorubicin.
Based on the results from the earlier CCG-3881 study, investigators determined that the less-intense regimen would be effective if more than 90 percent of A3961 participants were alive after three years of follow up.
The trial was organized by the Children’s Oncology Group. The lead author of the study is David L. Baker, M.B.B.S., director of the pediatric and adolescent hematology-oncology program at Princess Margaret Hospital for Children, Perth, Australia.
Results
Of the 467 eligible patients, 362 were infants (under 1 year of age) and 105 were children. Seventy-one percent (330) of all patients had a favorable prognosis, and 29 percent (137) had an unfavorable prognosis. A total of 192 patients received only four cycles of chemotherapy. The other 275 received eight cycles (including 42 percent of those in the favorable prognosis group).
At three years of follow up, 96 percent of patients remained alive and 88 percent had no progression of their cancer, an outcome indicating that the treatment was indeed effective. What’s more, the patients’ overall length of treatment and the actual number of treatment days were much less compared to the CCG-3881 historical controls.
In the earlier study using a higher-intensity regimen, patients received 71 days of treatment over the course of 268 days. In the A3961 lower-intensity study, patients with an unfavorable prognosis received 18 days of treatment (a 75 percent reduction) over the course of 168 days (a 40 percent reduction). Patients in the favorable group received 10 days of treatment (an 85 percent reduction) over the course of 84 days (a 70 percent reduction).
Damage to the kidneys, heart, and hearing each occurred in less than 2 percent of patients. Almost 70 percent of patients experienced a reduction in their number of white blood cells, but this side effect went away after treatment ended. Four of the 467 patients died from treatment-related infections during the trial. Two patients developed a second cancer - acute myeloid leukemia.
Limitations
While the overall side effects were acceptable after three years of follow up, “the long-term toxicity is unknown,” said pediatric oncologist Andrew Pearson from the Royal Marsden Hospital, Surrey, United Kingdom, in a discussion at the ASCO meeting. Because patients in the unfavorable prognosis group still received a substantial dose of doxorubicin (which can permanently damage the heart), and because several cases of second cancers have already been observed, he explained, “we must aim to reduce therapy even more in this group of patients.”
Comments
Even with further room for improvement in toxicity reduction, “Without question, this is a major success,” said Pearson.
“Their goal was to have an equivalent survival outcome while using much less treatment [compared to the historical control group], and they were able to do that. It’s significant that they were able to get that same outcome with about half the number of cycles of chemotherapy,” agreed Barry Anderson, M.D., Ph.D., of the National Cancer Institute’s Cancer Therapy Evaluation Program.
sources:
Background
Neuroblastoma, the fourth most common solid tumor in children under the age of 16, begins in immature nerve cells, most often in the adrenal gland, neck, chest, or spinal cord. Neuroblastoma is classified as low, intermediate, or high risk of disease recurrence after treatment, based on factors such as the patient’s age, how far the disease has spread (metastasized), and what genetic mutations are found in the tumor.
For neuroblastoma tumors that have already spread within a limited region at the time of diagnosis, doctors can use a combination of surgery and chemotherapy to kill both the original tumor and cancer cells elsewhere. For children with intermediate-risk neuroblastoma, this treatment approach is very effective at preventing the cancer from returning and also increases survival.
However, while effective, this approach requires many months to complete and causes potentially serious side effects, including damage to the kidneys, heart, and hearing as well as a temporary decrease in white blood cells that can expose the patient to dangerous infections.
The clinical trial described below examined whether a shorter, less-intense course of chemotherapy could be as effective in preventing disease recurrence and extending survival as more-intense regimens in children with intermediate-risk neuroblastoma.
The Study
Between March 1997 and May 2005, this single-arm phase III clinical trial (called A3961) enrolled 467 eligible patients with intermediate-risk neuroblastoma from participating hospitals in Australia, New Zealand, and North America. The study used historical patient controls. That is, the investigators compared the results from the A3961 trial to an earlier study (called CCG 3881) performed by the Children’s Cancer Group among a similar population of neuroblastoma patients who had received a more-intense chemotherapy regimen between 1989 and 1996.
All participants in the A3961 trial underwent initial surgery, and were divided into two groups based on the relative likelihood of tumor recurrence—a ‘favorable’ prognosis group and an ‘unfavorable’ prognosis group.
Infants and children in the favorable-prognosis group were scheduled to receive four cycles of chemotherapy, and those in the unfavorable-prognosis group were scheduled to receive eight cycles. If a patient in the favorable-prognosis group did not experience a satisfactory tumor response to the initial treatment, the patient could receive the full eight cycles of chemotherapy. The cycles consisted of different combinations of the drugs carboplatin, etoposide, cyclophosphamide, and doxorubicin.
Based on the results from the earlier CCG-3881 study, investigators determined that the less-intense regimen would be effective if more than 90 percent of A3961 participants were alive after three years of follow up.
The trial was organized by the Children’s Oncology Group. The lead author of the study is David L. Baker, M.B.B.S., director of the pediatric and adolescent hematology-oncology program at Princess Margaret Hospital for Children, Perth, Australia.
Results
Of the 467 eligible patients, 362 were infants (under 1 year of age) and 105 were children. Seventy-one percent (330) of all patients had a favorable prognosis, and 29 percent (137) had an unfavorable prognosis. A total of 192 patients received only four cycles of chemotherapy. The other 275 received eight cycles (including 42 percent of those in the favorable prognosis group).
At three years of follow up, 96 percent of patients remained alive and 88 percent had no progression of their cancer, an outcome indicating that the treatment was indeed effective. What’s more, the patients’ overall length of treatment and the actual number of treatment days were much less compared to the CCG-3881 historical controls.
In the earlier study using a higher-intensity regimen, patients received 71 days of treatment over the course of 268 days. In the A3961 lower-intensity study, patients with an unfavorable prognosis received 18 days of treatment (a 75 percent reduction) over the course of 168 days (a 40 percent reduction). Patients in the favorable group received 10 days of treatment (an 85 percent reduction) over the course of 84 days (a 70 percent reduction).
Damage to the kidneys, heart, and hearing each occurred in less than 2 percent of patients. Almost 70 percent of patients experienced a reduction in their number of white blood cells, but this side effect went away after treatment ended. Four of the 467 patients died from treatment-related infections during the trial. Two patients developed a second cancer - acute myeloid leukemia.
Limitations
While the overall side effects were acceptable after three years of follow up, “the long-term toxicity is unknown,” said pediatric oncologist Andrew Pearson from the Royal Marsden Hospital, Surrey, United Kingdom, in a discussion at the ASCO meeting. Because patients in the unfavorable prognosis group still received a substantial dose of doxorubicin (which can permanently damage the heart), and because several cases of second cancers have already been observed, he explained, “we must aim to reduce therapy even more in this group of patients.”
Comments
Even with further room for improvement in toxicity reduction, “Without question, this is a major success,” said Pearson.
“Their goal was to have an equivalent survival outcome while using much less treatment [compared to the historical control group], and they were able to do that. It’s significant that they were able to get that same outcome with about half the number of cycles of chemotherapy,” agreed Barry Anderson, M.D., Ph.D., of the National Cancer Institute’s Cancer Therapy Evaluation Program.
sources:
Neuroblastoma Treatment..
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
Low-Risk Neuroblastoma
Treatment of low-risk neuroblastoma may include the following:
* Watchful waiting alone for certain infants.
* Surgery followed by watchful waiting.
* Surgery followed by combination chemotherapy, when serious health problems occur.
* Radiation therapy to treat tumors that are causing serious health problems and do not respond quickly to chemotherapy.
* A clinical trial of surgery followed by chemotherapy. Radiation therapy is given to treat tumors that are causing serious health problems and do not respond quickly to surgery and chemotherapy.
Intermediate-Risk Neuroblastoma
Treatment of intermediate-risk neuroblastoma may include the following:
* Surgery alone.
* Surgery followed by chemotherapy. Sometimes a second surgery is needed.
* Surgery followed by chemotherapy. Radiation therapy may given to treat tumors that are causing serious health problems and do not respond quickly to surgery and chemotherapy.
* Chemotherapy followed by surgery.
* Radiation therapy to treat tumors that are causing serious problems and do not respond quickly to chemotherapy.
* A clinical trial of lower doses of chemotherapy.
High-Risk Neuroblastoma
Treatment of high-risk neuroblastoma may include the following:
* Combination chemotherapy followed by surgery to remove as much of the tumor as possible, followed by high-dose chemotherapy and stem cell transplant.
* Radiation therapy to the tumor site and, sometimes, if needed, to other parts of the body with cancer.
* 13-cis retinoic acid after recovery from previous treatment.
* A clinical trial of new regimens of chemotherapy and radiation therapy with stem cell transplant.
* A clinical trial of monoclonal antibody therapy, biologic therapy, and 13-cis retinoic acid after chemotherapy.
* A clinical trial of radiation therapy with radioactive iodine and chemotherapy before stem cell transplant.
Progressive/Recurrent Neuroblastoma
Patients First Treated for Low-Risk Neuroblastoma
Treatment for recurrent neuroblastoma that is found in one place in the body may include the following:
* Surgery followed by watchful waiting or chemotherapy.
* High-dose chemotherapy, stem cell transplant, and 13-cis retinoic acid.
* A clinical trial of surgery and if needed, chemotherapy and another surgery.
Treatment for recurrent neuroblastoma that has spread to other parts of the body may include the following:
* Watchful waiting.
* Surgery followed by chemotherapy.
* High-dose chemotherapy, stem cell transplant, and 13-cis retinoic acid.
* A clinical trial of a new treatment.
Patients First Treated for Intermediate-Risk Neuroblastoma
Treatment for recurrent neuroblastoma that is found in one place in the body may include the following:
* Surgery, with or without chemotherapy.
* A clinical trial of surgery and more courses of chemotherapy.
* A clinical trial of a new treatment.
For recurrent neuroblastoma that has spread to other parts of the body, treatment is usually high-dose chemotherapy, stem cell transplant, and 13-cis retinoic acid.
Patients First Treated for High-Risk Neuroblastoma
There is no standard treatment for recurrent neuroblastoma in patients first treated for high-risk neuroblastoma. Patients may want to consider a clinical trial. For information about clinical trials, please see the NCI Web site.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with neuroblastoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Sources:http://www.cancer.gov/cancertopics/pdq/treatment/neuroblastoma/Patient/page5
Low-Risk Neuroblastoma
Treatment of low-risk neuroblastoma may include the following:
* Watchful waiting alone for certain infants.
* Surgery followed by watchful waiting.
* Surgery followed by combination chemotherapy, when serious health problems occur.
* Radiation therapy to treat tumors that are causing serious health problems and do not respond quickly to chemotherapy.
* A clinical trial of surgery followed by chemotherapy. Radiation therapy is given to treat tumors that are causing serious health problems and do not respond quickly to surgery and chemotherapy.
Intermediate-Risk Neuroblastoma
Treatment of intermediate-risk neuroblastoma may include the following:
* Surgery alone.
* Surgery followed by chemotherapy. Sometimes a second surgery is needed.
* Surgery followed by chemotherapy. Radiation therapy may given to treat tumors that are causing serious health problems and do not respond quickly to surgery and chemotherapy.
* Chemotherapy followed by surgery.
* Radiation therapy to treat tumors that are causing serious problems and do not respond quickly to chemotherapy.
* A clinical trial of lower doses of chemotherapy.
High-Risk Neuroblastoma
Treatment of high-risk neuroblastoma may include the following:
* Combination chemotherapy followed by surgery to remove as much of the tumor as possible, followed by high-dose chemotherapy and stem cell transplant.
* Radiation therapy to the tumor site and, sometimes, if needed, to other parts of the body with cancer.
* 13-cis retinoic acid after recovery from previous treatment.
* A clinical trial of new regimens of chemotherapy and radiation therapy with stem cell transplant.
* A clinical trial of monoclonal antibody therapy, biologic therapy, and 13-cis retinoic acid after chemotherapy.
* A clinical trial of radiation therapy with radioactive iodine and chemotherapy before stem cell transplant.
Progressive/Recurrent Neuroblastoma
Patients First Treated for Low-Risk Neuroblastoma
Treatment for recurrent neuroblastoma that is found in one place in the body may include the following:
* Surgery followed by watchful waiting or chemotherapy.
* High-dose chemotherapy, stem cell transplant, and 13-cis retinoic acid.
* A clinical trial of surgery and if needed, chemotherapy and another surgery.
Treatment for recurrent neuroblastoma that has spread to other parts of the body may include the following:
* Watchful waiting.
* Surgery followed by chemotherapy.
* High-dose chemotherapy, stem cell transplant, and 13-cis retinoic acid.
* A clinical trial of a new treatment.
Patients First Treated for Intermediate-Risk Neuroblastoma
Treatment for recurrent neuroblastoma that is found in one place in the body may include the following:
* Surgery, with or without chemotherapy.
* A clinical trial of surgery and more courses of chemotherapy.
* A clinical trial of a new treatment.
For recurrent neuroblastoma that has spread to other parts of the body, treatment is usually high-dose chemotherapy, stem cell transplant, and 13-cis retinoic acid.
Patients First Treated for High-Risk Neuroblastoma
There is no standard treatment for recurrent neuroblastoma in patients first treated for high-risk neuroblastoma. Patients may want to consider a clinical trial. For information about clinical trials, please see the NCI Web site.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with neuroblastoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Sources:http://www.cancer.gov/cancertopics/pdq/treatment/neuroblastoma/Patient/page5
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