Lessons From Pediatric HIV: A Case for Curative Intent in Pediatric Cancer in LMICs

Miller, Henry S.; Slone, Jeremy S.; Raabe, Eric H.; El‐Mallawany, Nader Kim; Mehta, Parth; Phelps, B. Ryan

doi:10.1542/peds.2017-0525

Cited by 6 publications

(4 citation statements)

References 7 publications

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“…As one of the most common overall childhood cancers in numerous countries in central, eastern, and southern Africa, there is a definite need for improved therapeutic strategies, especially with expanding pediatric HIV and oncology treatment infrastructure throughout the region. 81 …”

Section: Future Directionsmentioning

confidence: 99%

Pediatric Kaposi sarcoma in context of the HIV epidemic in sub-Saharan Africa: current perspectives

El‐Mallawany¹,

McAtee²,

Campbell³

et al. 2018

PHMT

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The global experience with pediatric Kaposi sarcoma (KS) has evolved immensely since the onset of HIV (human immunodeficiency virus). In this review, current perspectives on childhood KS are discussed in the context of the HIV epidemic in sub-Saharan Africa. Endemic (HIV-unrelated) KS was first described over 50 years ago in central and eastern Africa, regions where human herpesvirus-8, the causative agent of KS, is endemic. With the alarming rise in HIV prevalence over the past few decades, KS has become not only the most common HIV-related malignancy in Africa, but also one of the most common overall childhood cancers throughout the central, eastern, and southern regions of the continent. The unique clinical features of pediatric KS that were described in those early endemic KS reports have been re-affirmed by the contemporary experience with HIV-related KS. These characteristics include a predilection for primary lymph node involvement, significant proportions of patients lacking prototypical cutaneous lesions, and the potential for fulminant disease progression. Other clinical features that distinguish childhood KS from adult disease include disease presentation with severe cytopenias, and the common occurrence of childhood KS without severe CD4 count suppression. Distinct clinical heterogeneity in disease presentation and treatment response have been demonstrated. Long-term complete remission and event-free survival can be achieved—especially in children with lymphadenopathic KS—utilizing treatment with antiretroviral therapy plus mild–moderate chemotherapy regimens that are well tolerated, even in low-income settings. A pediatric-specific staging classification and risk-stratification platform have been retrospectively validated, and may help guide therapeutic strategies. With expansion of the HIV treatment infrastructure throughout Africa, coupled with recent developments in establishing comprehensive pediatric oncology programs, there is great potential for improving outcomes for children with KS. Increased awareness of the unique clinical nuances and collaborative evaluations of pediatric-specific treatment paradigms are required to optimize survival for children with KS.

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Section: Future Directionsmentioning

confidence: 99%

Pediatric Kaposi sarcoma in context of the HIV epidemic in sub-Saharan Africa: current perspectives

El‐Mallawany¹,

McAtee²,

Campbell³

et al. 2018

PHMT

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“…In Africa, collaborative programs turned the tides of the HIV/AIDS epidemic. 91 Collaborative clinical trial networks like the GFAOP are now required to systematically catalyze outcomes for children with cancer in SSA. 91 Multidisciplinary specialized services, including nursing, pharmacy, nutrition, diagnostic pathology, blood banking, radiology, palliative care, pediatric surgery, and critical care, are key to improving pediatric cancer survival.…”

Section: Discussionmentioning

confidence: 99%

“…91 Collaborative clinical trial networks like the GFAOP are now required to systematically catalyze outcomes for children with cancer in SSA. 91 Multidisciplinary specialized services, including nursing, pharmacy, nutrition, diagnostic pathology, blood banking, radiology, palliative care, pediatric surgery, and critical care, are key to improving pediatric cancer survival. Rational and feasible interim measures to improve outcomes of children with cancer in these settings should focus on adapting current best evidence to the resources, infrastructure, and putative unique biology of some of the cancers in children in LMICs.…”

Section: Discussionmentioning

confidence: 99%

Five decades of low intensity and low survival: adapting intensified regimens to cure pediatric Burkitt lymphoma in Africa

et al. 2020

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Long-term cure of childhood Burkitt lymphoma (BL) in sub-Saharan Africa after treatment with single-agent cyclophosphamide has been documented for more than half of a century. Contemporary cure rates for the highest-risk patients with BL in high-income countries exceed 90% using intensive multiagent chemotherapy. By contrast, the majority of African children with BL still die. Data spanning 5 decades in Africa have repeatedly shown that the children most likely to achieve cure with limited cyclophosphamide regimens are those with lower-stage disease isolated to the jaw. Attempts to intensify the cyclophosphamide monotherapy backbone with the addition of vincristine, low-dose methotrexate, prednisone, doxorubicin, and/or low-dose cytarabine have not yielded significant improvement. High-dose methotrexate is a critical component in the treatment of childhood BL worldwide. Although initial efforts in Africa to incorporate high-dose methotrexate resulted in high treatment-related mortality, more recent collaborative experiences from North and West Africa, as well as Central America, demonstrate that it can be administered safely and effectively, despite limitations in supportive care resources. Recognizing the unacceptable disparity in curative outcomes for BL between the United States/Europe and equatorial Africa, there is a critical need to safely adapt contemporary treatment regimens to optimize curative outcomes amid the resource limitations in regions where BL is endemic. Here, we critically review reports of BL treatment outcomes from low- and middle-income countries, in addition to data from high-income countries that predated modern intensified regimens, to identify potential strategies to improve the therapeutic approach for children suffering from BL in sub-Saharan Africa.

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“…This will not be unprecedented, as adapting resources and systems developed for the HIV epidemic have been leveraged to address pediatric cancer and blood disorders in Africa. 11 The following are recognized as areas of potential opportunities to build upon the COVID response to improve systems for diagnosing and managing children with cancer and blood disorders.…”

mentioning

confidence: 99%

Caring for Children with Cancer in Africa during the COVID-19 Crisis: Implications and Opportunities

Slone

Ozuah

Wasswa

2020

Pediatric Hematology and Oncology

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Africa has been here before! The human immunodeficiency virus (HIV) epidemic ravaged across most of the continent. Then, the regional outbreaks of the very transmissible and fatal Ebola virus. Now, a new and highly infectious organism again threatens the continent as well as the entire world. The coronavirus disease that emerged in late 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), has led to a worldwide pandemic. It has also created an environment where children with cancer and blood disorders in low and middle-income countries (LMICs) across the globe, such as in Africa, may now have even less access to care than before. This epidemic compounds one of the greatest global health care tragedies-the disparity where 80% of children with cancer living in LMICs succumb to their disease compared to over 80% survival for childhood cancer patients in the United States and other high income countries (HICs). 1 The public health emergency created by COVID-19 has created a seismic shift in health care priorities and focus. Examples abound in HICs of individuals with chronic noncommunicable diseases (NCDs) being restricted access to vital medical care as a result of the ripple effects of the COVID pandemic. 2 Due to the collateral damage of COVID-19, it has been estimated that a 5-10% decrease in cancer survival will occur in adults with cancer in HICs. 3 It is impossible to know to what degree, but it can be assumed that the impact in LMICs will be even more significant. Children's access to health care as well as food is predicted to be impacted by the pandemic. 4 Health systems in Africa, already suffering from a lack of resources and sound infrastructure to appropriately address NCDs, may be pushed to the brink by the demands to meet this gripping pandemic. Even before COVID-19, cancer care in Africa faced many challenges that are only being exacerbated by this new pandemic. 5 To avoid

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Lessons From Pediatric HIV: A Case for Curative Intent in Pediatric Cancer in LMICs

Cited by 6 publications

References 7 publications

Pediatric Kaposi sarcoma in context of the HIV epidemic in sub-Saharan Africa: current perspectives

Pediatric Kaposi sarcoma in context of the HIV epidemic in sub-Saharan Africa: current perspectives

Five decades of low intensity and low survival: adapting intensified regimens to cure pediatric Burkitt lymphoma in Africa

Caring for Children with Cancer in Africa during the COVID-19 Crisis: Implications and Opportunities

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