Additional Therapies to Improve Metastatic Response to Induction Therapy in Children With High-risk Neuroblastoma

Abstract

Children with high-risk neuroblastoma who fail to achieve adequate metastatic response after induction chemotherapy have dismal outcome and new therapeutic strategies are needed. However, timing of introduction of novel agents still remains under discussion. Given an increase in number of phase I-II studies of molecularly targeted drugs in neuroblastoma, it is crucial to determine, as early as possible, which patients may be suitable candidates for new therapeutic strategies. This single-center retrospective analysis of patients with high-risk neuroblastoma showed that the addition of conventional chemotherapy improved the quality of metastatic response only for the group of patients with partial response. It is therefore proposed to develop stratification criteria for those patients very unlikely to benefit from a plethora of additional lines of treatment, but might benefit from introduction of novel agents.

Outcome of children with relapsed or refractory neuroblastoma: A meta‐analysis of ITCC/SIOPEN European phase II clinical trials

“…Outcome data including time on trial, number of cycles received, responses per protocol criteria, timing of the responses, and events are summarized in Table . Patients were on trial for a median of 3.5 months . Twenty‐one of them (30%) experienced CR or PR as per protocol‐defined criteria.…”

“…In our analysis, this population generally received fewer treatment modalities (no HDCSCR or radiotherapy). This cohort may have long‐term benefit if response to subsequent therapies is achieved, subsequently proceeding to consolidation and minimal residual disease‐type treatment including differentiating therapy and immunotherapy . Prolonged disease stabilization in cases with refractory neuroblastoma has been seen in other early clinical trials of targeted therapies .…”

Overview and recent advances in the treatment of neuroblastoma

“…Further genomic and proteomic analyses of these patients and their tumors are critical for both understanding the underlying mechanisms of treatment resistance as well as identifying novel targets for therapy. Some investigators have proposed considering these patients for phase I and II clinical trials with novel agents prior to attempting consolidation in hopes of improving clinical outcomes [69].…”

Apoptotic-induced Effects of Castanea sativa Bark Extract in Human SH-SY5Y Neuroblastoma Cells

“…It is treated with highly toxic chemotherapy, surgery and bone marrow transplantation, but due to the toxic side effects of chemotherapy, survivors frequently have lifelong health issues from the therapy they received as a child [11]. Despite the outcome of children with neuroblastoma has improved over the last three decades, long-term survivors remain at significant risk for a second malignancy such as head and neck cancer [12]. Therefore, targeted and less toxic therapies are urgently required to treat this disease, to improve the quality of life of the survivors and possibly to prevent the occurrence of a second malignancy.…”