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Clinical research on rare diseases of children: neuroblastoma. Cancer Chemother Pharmacol 2016; 79:267-273. [PMID: 27878358 DOI: 10.1007/s00280-016-3195-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/11/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE Early access to new treatment options should not preclude accurate research planning, especially for rare diseases and fragile populations. Taking neuroblastoma as a model case, we analyzed the rationale supporting the search for future therapeutic strategies in the light of preclinical and clinical evidence. METHODS We reviewed ongoing randomized trials of pharmacological interventions for the treatment of neuroblastoma retrieved by searching ClinicalTrials.gov and the European Union Clinical Trials Registry (last update March 2016). RESULTS Our search identified four randomized clinical trial reports. We found poor evidence from preclinical and early clinical research supporting their rationale. Their methodology was questionable too. CONCLUSIONS The urgency to cover unmet needs in difficult clinical settings like rare diseases, particularly those involving fragile populations, cannot justify disorderly research approaches. Under these circumstances, clinical questions should be properly identified and addressed to protect patients and avoid wasteful research.
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Shinagawa T, Kitamura T, Katanoda K, Matsuda T, Ito Y, Sobue T. The incidence and mortality rates of neuroblastoma cases before and after the cessation of the mass screening program in Japan: A descriptive study. Int J Cancer 2016; 140:618-625. [DOI: 10.1002/ijc.30482] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/05/2016] [Accepted: 10/13/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Takafumi Shinagawa
- Department of Social Medicine, Division of Environmental Medicine and Population Sciences, Graduate School of Medicine; Osaka University; Osaka Japan
| | - Tetsuhisa Kitamura
- Department of Social Medicine, Division of Environmental Medicine and Population Sciences, Graduate School of Medicine; Osaka University; Osaka Japan
| | - Kota Katanoda
- Center for Cancer Registries, Center for Cancer Control and Information Services, National Cancer Center; Tokyo Japan
| | - Tomohiro Matsuda
- Center for Cancer Registries, Center for Cancer Control and Information Services, National Cancer Center; Tokyo Japan
| | - Yuri Ito
- Department of Cancer Epidemiology and Prevention; Center for Cancer Control and Statistics; Osaka Japan
| | - Tomotaka Sobue
- Department of Social Medicine, Division of Environmental Medicine and Population Sciences, Graduate School of Medicine; Osaka University; Osaka Japan
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Shieh Y, Eklund M, Sawaya GF, Black WC, Kramer BS, Esserman LJ. Population-based screening for cancer: hope and hype. Nat Rev Clin Oncol 2016; 13:550-65. [PMID: 27071351 PMCID: PMC6585415 DOI: 10.1038/nrclinonc.2016.50] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Several important lessons have been learnt from our experiences in screening for various cancers. Screening programmes for cervical and colorectal cancers have had the greatest success, probably because these cancers are relatively homogenous, slow-growing, and have identifiable precursors that can be detected and removed; however, identifying the true obligate precursors of invasive disease remains a challenge. With regard to screening for breast cancer and for prostate cancer, which focus on early detection of invasive cancer, preferential detection of slower-growing, localized cancers has occurred, which has led to concerns about overdiagnosis and overtreatment; programmes for early detection of invasive lung cancers are emerging, and have faced similar challenges. A crucial consideration in screening for breast, prostate, and lung cancers is their remarkable phenotypic heterogeneity, ranging from indolent to highly aggressive. Efforts have been made to address the limitations of cancer-screening programmes, providing an opportunity for cross-disciplinary learning and further advancement of the science. Current innovations are aimed at identifying the individuals who are most likely to benefit from screening, increasing the yield of consequential cancers on screening and biopsy, and using molecular tests to improve our understanding of disease biology and to tailor treatment. We discuss each of these concepts and outline a dynamic framework for continuous improvements in the field of cancer screening.
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Affiliation(s)
- Yiwey Shieh
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, 1545 Divisadero Street, San Francisco, California 94115, USA
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17177 Stockholm, Sweden
| | - George F Sawaya
- Departments of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, California 94158, USA
| | - William C Black
- Department of Radiology, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, New Hampshire 03756, USA
| | - Barnett S Kramer
- Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Bethesda, Maryland 20892, USA
| | - Laura J Esserman
- Departments of Surgery and Radiology, University of California, San Francisco, 1600 Divisadero Street, Box 1710, San Francisco, California 94115, USA
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Affiliation(s)
- Kota Katanoda
- Center for Cancer Registries, Center for Cancer Control and Information Services, National Cancer Center
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Ratner N, Brodeur GM, Dale RC, Schor NF. The "neuro" of neuroblastoma: Neuroblastoma as a neurodevelopmental disorder. Ann Neurol 2016; 80:13-23. [PMID: 27043043 DOI: 10.1002/ana.24659] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/28/2016] [Accepted: 03/28/2016] [Indexed: 12/11/2022]
Abstract
Neuroblastoma is a childhood cancer derived from cells of neural crest origin. The hallmarks of its enigmatic character include its propensity for spontaneous regression under some circumstances and its association with paraneoplastic opsoclonus, myoclonus, and ataxia. The neurodevelopmental underpinnings of its origins may provide important clues for development of novel therapeutic and preventive agents for this frequently fatal malignancy and for the associated paraneoplastic syndromes. Ann Neurol 2016;80:13-23.
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Affiliation(s)
- Nancy Ratner
- Department of Pediatrics, Cincinnati Children's Hospital and University of Cincinnati, Cincinnati, OH
| | - Garrett M Brodeur
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Russell C Dale
- Clinical School, the Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia
| | - Nina F Schor
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
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Regairaz M, Munier F, Sartelet H, Castaing M, Marty V, Renauleaud C, Doux C, Delbé J, Courty J, Fabre M, Ohta S, Vielh P, Michiels S, Valteau-Couanet D, Vassal G. Mutation-Independent Activation of the Anaplastic Lymphoma Kinase in Neuroblastoma. THE AMERICAN JOURNAL OF PATHOLOGY 2015; 186:435-45. [PMID: 26687816 DOI: 10.1016/j.ajpath.2015.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 08/28/2015] [Accepted: 10/20/2015] [Indexed: 11/30/2022]
Abstract
Activating mutations of anaplastic lymphoma kinase (ALK) have been identified as important players in neuroblastoma development. Our goal was to evaluate the significance of overall ALK activation in neuroblastoma. Expression of phosphorylated ALK, ALK, and its putative ligands, pleiotrophin and midkine, was screened in 289 neuroblastomas and 56 paired normal tissues. ALK was expressed in 99% of tumors and phosphorylated in 48% of cases. Pleiotrophin and midkine were expressed in 58% and 79% of tumors, respectively. ALK activation was significantly higher in tumors than in paired normal tissues, together with ALK and midkine expression. ALK activation was largely independent of mutations and correlated with midkine expression in tumors. ALK activation in tumors was associated with favorable features, including a younger age at diagnosis, hyperdiploidy, and detection by mass screening. Antitumor activity of the ALK inhibitor TAE684 was evaluated in wild-type or mutated ALK neuroblastoma cell lines and xenografts. TAE684 was cytotoxic in vitro in all cell lines, especially those harboring an ALK mutation. TAE684 efficiently inhibited ALK phosphorylation in vivo in both F1174I and R1275Q xenografts but demonstrated antitumor activity only against the R1275Q xenograft. In conclusion, ALK activation occurs frequently during neuroblastoma oncogenesis, mainly through mutation-independent mechanisms. However, ALK activation is not associated with a poor outcome and is not always a driver of cell proliferation and/or survival in neuroblastoma.
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Affiliation(s)
- Marie Regairaz
- Laboratory for Vectorology and Anticancer Therapeutics, Gustave Roussy, Paris-Sud University, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8203, Villejuif, France.
| | - Fabienne Munier
- Laboratory for Vectorology and Anticancer Therapeutics, Gustave Roussy, Paris-Sud University, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8203, Villejuif, France
| | - Hervé Sartelet
- Laboratory for Vectorology and Anticancer Therapeutics, Gustave Roussy, Paris-Sud University, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8203, Villejuif, France; Sainte Justine University Hospital Center, University of Montréal, Montréal, Québec, Canada
| | - Marine Castaing
- Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France
| | - Virginie Marty
- Histocytopathology Unit, Laboratory of Translational Research, Gustave Roussy, Villejuif, France
| | - Céline Renauleaud
- Laboratory for Vectorology and Anticancer Therapeutics, Gustave Roussy, Paris-Sud University, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8203, Villejuif, France
| | - Camille Doux
- Laboratory for Vectorology and Anticancer Therapeutics, Gustave Roussy, Paris-Sud University, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8203, Villejuif, France
| | - Jean Delbé
- Research on Cell Growth, Tissue Repair and Regeneration (CRRET), Centre National de la Recherche Scientifique, University Paris-Est Créteil, Créteil, France
| | - José Courty
- Research on Cell Growth, Tissue Repair and Regeneration (CRRET), Centre National de la Recherche Scientifique, University Paris-Est Créteil, Créteil, France
| | - Monique Fabre
- Department of Pathology, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Shigeru Ohta
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Philippe Vielh
- Histocytopathology Unit, Laboratory of Translational Research, Gustave Roussy, Villejuif, France; Department of Pathology and Biobank, Gustave Roussy, Villejuif, France
| | - Stefan Michiels
- Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France
| | | | - Gilles Vassal
- Laboratory for Vectorology and Anticancer Therapeutics, Gustave Roussy, Paris-Sud University, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8203, Villejuif, France.
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Ioka A, Inoue M, Yoneda A, Nakamura T, Hara J, Hashii Y, Sakata N, Yamato K, Tsukuma H, Kawa K. Effects of the Cessation of Mass Screening for Neuroblastoma at 6 Months of Age: A Population-Based Study in Osaka, Japan. J Epidemiol 2015; 26:179-84. [PMID: 26548355 PMCID: PMC4808684 DOI: 10.2188/jea.je20150054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In 2004, the Japanese government halted the 6-month mass screening program for neuroblastoma. We investigated whether its cessation had led to an increase not only in mortality due to this disease but also in the incidence of advanced-stage disease among older children. Methods Study subjects were neuroblastoma patients retrieved from the population-based Osaka Cancer Registry. Trends of incidence and mortality from neuroblastoma were analyzed by calendar year and birth cohort. Prognostic factors, including stage and v-myc avian myelocytomatosis viral oncogene neuroblastoma derived homolog (MYCN) oncogene status, were compared before and after the cessation of mass screening. Results Age-standardized incidence rates in 2005–2009 (the cessation period of mass screening; 11.1 per million) were similar to those in 1975–1979 (the pre-screening period; 8.6 per million). Age-standardized mortality rates tended to decrease from 1975–1979 (4.0 per million) to 2005–2009 (2.7 per million) in parallel with the improvement in survival. Analysis by birth cohort indicated that the mortality rates in 2004–2005 (after cessation) for children 0–4 years of age were lower than those in 1975–1979 (O:E ratio 0.25; 95% confidence interval, 0.03–0.90). For children 1–9 years of age, there was a not significant difference in the distribution of stage, MYCN oncogene status, and DNA ploidy between 1991–2003 (the mass screening period) and 2004–2008 (after cessation). Conclusions The cessation of mass screening for neuroblastoma does not appear to have increased mortality due to this disease or incidence of advanced-stage disease among older children.
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Affiliation(s)
- Akiko Ioka
- Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases
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Ikeda H, Nakamura Y. Trends in incidence of childhood malignant solid tumors in Japan: Estimation based on hospital-based registration. J Pediatr Surg 2015; 50:1506-12. [PMID: 25783293 DOI: 10.1016/j.jpedsurg.2014.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 12/12/2014] [Accepted: 12/15/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND/PURPOSE In Japan, an increase in hepatoblastoma with low birth weight has become evident since the 1990 s, and there is concern about a possible increase in unfavorable neuroblastomas after the cessation of mass screening in 2004. METHODS The trends in incidence of malignant solid tumors in children younger than 15 years of age were inferred by evaluating registration incidence in the registry of the Japanese Society of Pediatric Surgeons. RESULTS A significant trend toward an increase in the registration incidence for hepatoblastoma was observed (p<0.001). Hepatoblastomas with low birth weight (<1500 g) represented as many as 16% of hepatoblastomas. In hepatocellular carcinoma, there was a significant trend toward a decrease (p=0.042). The registration incidence of nonmass screening-detected neuroblastoma remained unchanged until 2003, but the registration incidence in the period from 2004 to 2012 was significantly higher than that in the period from 1996 to 2003 (p=0.021). There was an increase in the relative incidence of favorable stages after the cessation of mass screening. CONCLUSIONS The notable increase in hepatoblastoma during the last three decades is partly attributed to an increase in hepatoblastoma in children of low birth weight, but this alone is not sufficient to explain the increase in hepatoblastoma. The increase in neuroblastoma after the halt of mass screening is so minimal that it is not recommended to consider reimplementation of mass screening.
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Affiliation(s)
- Hitoshi Ikeda
- Department of Pediatric Surgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan.
| | - Yosikazu Nakamura
- Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan
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59
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Spix C, Berthold F, Hero B, Michaelis J, Schilling FH. Correction factors for self-selection when evaluating screening programmes. J Med Screen 2015. [DOI: 10.1177/0969141315597959] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective In screening programmes there is recognized bias introduced through participant self-selection (the healthy screenee bias). Methods used to evaluate screening programmes include Intention-to-screen, per-protocol, and the “post hoc” approach in which, after introducing screening for everyone, the only evaluation option is participants versus non-participants. All methods are prone to bias through self-selection. We present an overview of approaches to correct for this bias. Methods We considered four methods to quantify and correct for self-selection bias. Simple calculations revealed that these corrections are actually all identical, and can be converted into each other. Based on this, correction factors for further situations and measures were derived. The application of these correction factors requires a number of assumptions. Results Using as an example the German Neuroblastoma Screening Study, no relevant reduction in mortality or stage 4 incidence due to screening was observed. The largest bias (in favour of screening) was observed when comparing participants with non-participants. Conclusions Correcting for bias is particularly necessary when using the post hoc evaluation approach, however, in this situation not all required data are available. External data or further assumptions may be required for estimation.
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Affiliation(s)
- Claudia Spix
- University Medical Center Mainz, IMBEI, German Childhood Cancer Registry, Mainz, Germany
| | - Frank Berthold
- University Children’s Hospital, Pediatric Oncology/Hematology, Koeln, Germany
| | - Barbara Hero
- University Children’s Hospital, Pediatric Oncology/Hematology, Koeln, Germany
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Koh V, Soh SY, Chan MY, Tan AM. Neuroblastoma in Children Under 12 Months in Singapore--15-Year Experience and Outcomes From KKH. Fetal Pediatr Pathol 2015; 34:155-61. [PMID: 25616021 DOI: 10.3109/15513815.2014.999392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Expectant observation of small adrenal lesions has shown promising results in recent studies. We present our 15 years outcome of managing infant neuroblastoma. METHODS All patients with neuroblastoma below the age of 1 year treated at the largest pediatric hospital in Singapore between 1998 and 2012 were identified. RESULTS Twenty-two patients were included in our study. Six were antenatally diagnosed. Nineteen (86%) patients had surgical resection of the tumor. Eight (36%) patients received chemotherapy as part of their treatment. Six patients were observed three of which had large adrenal tumors. Median follow-up in our series was 2.6 years. The 5 year overall survival was 90%. There were no recurrences and there were 2 deaths in our series. CONCLUSION Our series shows excellent outcomes of infant neuroblastoma at our center. Careful observation of large tumors may be an option to avoid the morbidity of surgery.
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Affiliation(s)
- Vicky Koh
- Radiation Oncology, National University Cancer Institute , Singapore , Singapore
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Kembhavi SA, Shah S, Rangarajan V, Qureshi S, Popat P, Kurkure P. Imaging in neuroblastoma: An update. Indian J Radiol Imaging 2015; 25:129-36. [PMID: 25969636 PMCID: PMC4419422 DOI: 10.4103/0971-3026.155844] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Neuroblastoma is the third common tumor in children. Imaging plays an important role in the diagnosis, staging, treatment planning, response evaluation and in follow-up of a case of Neuroblastoma. The International Neuroblastoma Risk Group task force has recently introduced an imaging-based staging system and laid down guidelines for uniform reporting of imaging studies. This review is an update on imaging in neuroblastoma, with emphasis on these guidelines.
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Affiliation(s)
- Seema A Kembhavi
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Bio-imaging, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Sajid Qureshi
- Department of Surgery, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Palak Popat
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Purna Kurkure
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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Abstract
Horner syndrome consists of unilateral ptosis, an ipsilateral miotic but normally reactive pupil, and in some cases, ipsilateral facial anhidrosis, all resulting from damage to the ipsilateral oculosympathetic pathway. Herein, we review the clinical signs and symptoms that can aid in the diagnosis and localization of a Horner syndrome as well as the causes of the condition. We emphasize that pharmacologic testing can confirm its presence and direct further testing and management.
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Affiliation(s)
- Sivashakthi Kanagalingam
- Department of Ophthalmology.,Department of Neurology.,Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Neil R Miller
- Department of Ophthalmology.,Department of Neurology.,Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USA
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Marcus PM, Prorok PC, Miller AB, DeVoto EJ, Kramer BS. Conceptualizing overdiagnosis in cancer screening. J Natl Cancer Inst 2015; 107:djv014. [PMID: 25663695 DOI: 10.1093/jnci/djv014] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The aim of cancer screening is to detect asymptomatic cancers whose treatment will result in extension of life, relative to length of life absent screening. Unfortunately, cancer screening also results in overdiagnosis, the detection of cancers that, in the absence of screening, would not present symptomatically during one's lifetime. Thus, their detection and subsequent treatment is unnecessary and detrimental. This definition of overdiagnosis, while succinct, does not capture the ways it can occur, and our interactions with patients, advocates, researchers, clinicians, and journalists have led us to believe that the concept of overdiagnosis is difficult to explain and, for some, difficult to accept. We propose a dichotomy, the "tumor-patient" classification, to aid in understanding overdiagnosis. The tumor category includes asymptomatic malignant disease that would regress spontaneously if left alone, as well as asymptomatic malignant disease that stagnates or progresses too slowly to be life threatening in even the longest of lifetimes. The patient category includes asymptomatic malignant disease that would progress quickly enough to be life threatening during a lifetime of typical length, but lacks clinical relevance because death due to another cause intercedes prior to what would have been the date of symptomatic diagnosis had screening not occurred. Cancer screening of most organs is likely to result in overdiagnosis of both types. However, the ratio of tumor- to patient-driven overdiagnosis almost certainly varies, and may vary drastically, by organ, screening modality, patient characteristics, and other factors.
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Affiliation(s)
- Pamela M Marcus
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (PCP, BSK); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (ABM); no institutional affiliation, Norwich, England, UK (EJD).
| | - Philip C Prorok
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (PCP, BSK); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (ABM); no institutional affiliation, Norwich, England, UK (EJD)
| | - Anthony B Miller
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (PCP, BSK); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (ABM); no institutional affiliation, Norwich, England, UK (EJD)
| | - Emily J DeVoto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (PCP, BSK); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (ABM); no institutional affiliation, Norwich, England, UK (EJD)
| | - Barnett S Kramer
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (PCP, BSK); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (ABM); no institutional affiliation, Norwich, England, UK (EJD)
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Abstract
Neuroblastoma (NB) is the third most common pediatric cancer. Although NB accounts for 7% of pediatric malignancies, it is responsible for more than 10% of childhood cancer-related mortality. Prognosis and treatment are determined by clinical and biological risk factors. Estimated 5-year survival rates for patients with non-high-risk and high-risk NB are more than 90% and less than 50%, respectively. Recent clinical trials have continued to reduce therapy for patients with non-high-risk NB, including the most favorable subsets who are often followed with observation approaches. In contrast, high-risk patients are treated aggressively with chemotherapy, radiation, surgery, and myeloablative and immunotherapies.
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67
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Abstract
BACKGROUND Urinary dipsticks are sometimes used for screening asymptomatic people, and for case-finding among inpatients or outpatients who do not have genitourinary symptoms. Abnormalities identified on screening sometimes lead to additional investigations, which may identify serious disease, such as bladder cancer and chronic kidney disease (CKD). Urinary dipstick screening could improve prognoses due to earlier detection, but could also lead to unnecessary and potentially invasive follow-up testing and unnecessary treatment. OBJECTIVES We aimed to quantify the benefits and harms of screening with urinary dipsticks in general populations and patients in hospitals. SEARCH METHODS We searched the Cochrane Renal Group's Specialised Register to 8 September 2014 through contact with the Trials Search Co-ordinator using search terms relevant to this review. SELECTION CRITERIA Randomised controlled trials and other study types that compared urinary dipstick screening with no dipstick screening were eligible for inclusion. We searched for studies that investigated the use of urinary dipsticks for detecting haemoglobin, protein, albumin, albumin-creatinine ratio, leukocytes, nitrite, or glucose, alone or in any combination, and in any setting. We planned to exclude studies conducted in patients with urinary disorders. DATA COLLECTION AND ANALYSIS It was planned that two authors would independently extract data from included studies and assess risk of bias using the Cochrane risk of bias tool. However, no studies met our inclusion criteria. MAIN RESULTS Literature searches to 8 September 2014 yielded 4298 records, of which 4249 were excluded following title and abstract assessment. There were 49 records (44 studies) eligible for full text assessment; of these 18 studies were not RCTs and 26 studies compared interventions or controls that were not relevant to this review. Thus, no studies were eligible for inclusion. AUTHORS' CONCLUSIONS We found no evidence to assess the benefits and harms of screening with urinary dipsticks, which remain unknown.
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Affiliation(s)
- Lasse T Krogsbøll
- RigshospitaletThe Nordic Cochrane CentreBlegdamsvej 9, 7811CopenhagenDenmark2100
| | | | - Peter C Gøtzsche
- RigshospitaletThe Nordic Cochrane CentreBlegdamsvej 9, 7811CopenhagenDenmark2100
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Naqib ZA, Ahmed AA, Harbi MA, Manjomi FA, Khan ZU, Alanazi A, Mosleh O, Ballourah W, Rayis M. Neuroblastoma in Saudi Children: A Single Center Experience (2006-2014). ACTA ACUST UNITED AC 2015. [DOI: 10.4236/jct.2015.610098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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69
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Abstract
Recent genomic and biological studies of neuroblastoma have shed light on the dramatic heterogeneity in the clinical behaviour of this disease, which spans from spontaneous regression or differentiation in some patients, to relentless disease progression in others, despite intensive multimodality therapy. This evidence also suggests several possible mechanisms to explain the phenomena of spontaneous regression in neuroblastomas, including neurotrophin deprivation, humoral or cellular immunity, loss of telomerase activity and alterations in epigenetic regulation. A better understanding of the mechanisms of spontaneous regression might help to identify optimal therapeutic approaches for patients with these tumours. Currently, the most druggable mechanism is the delayed activation of developmentally programmed cell death regulated by the tropomyosin receptor kinase A pathway. Indeed, targeted therapy aimed at inhibiting neurotrophin receptors might be used in lieu of conventional chemotherapy or radiation in infants with biologically favourable tumours that require treatment. Alternative approaches consist of breaking immune tolerance to tumour antigens or activating neurotrophin receptor pathways to induce neuronal differentiation. These approaches are likely to be most effective against biologically favourable tumours, but they might also provide insights into treatment of biologically unfavourable tumours. We describe the different mechanisms of spontaneous neuroblastoma regression and the consequent therapeutic approaches.
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Affiliation(s)
- Garrett M Brodeur
- Division of Oncology, The Children's Hospital of Philadelphia, 3501 Civic Center Boulevard, Philadelphia, PA 19104-4302, USA
| | - Rochelle Bagatell
- Division of Oncology, The Children's Hospital of Philadelphia, 3501 Civic Center Boulevard, Philadelphia, PA 19104-4302, USA
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Coon ER, Quinonez RA, Moyer VA, Schroeder AR. Overdiagnosis: how our compulsion for diagnosis may be harming children. Pediatrics 2014; 134:1013-23. [PMID: 25287462 DOI: 10.1542/peds.2014-1778] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Overdiagnosis occurs when a true abnormality is discovered, but detection of that abnormality does not benefit the patient. It should be distinguished from misdiagnosis, in which the diagnosis is inaccurate, and it is not synonymous with overtreatment or overuse, in which excess medication or procedures are provided to patients for both correct and incorrect diagnoses. Overdiagnosis for adult conditions has gained a great deal of recognition over the last few years, led by realizations that certain screening initiatives, such as those for breast and prostate cancer, may be harming the very people they were designed to protect. In the fall of 2014, the second international Preventing Overdiagnosis Conference will be held, and the British Medical Journal will produce an overdiagnosis-themed journal issue. However, overdiagnosis in children has been less well described. This special article seeks to raise awareness of the possibility of overdiagnosis in pediatrics, suggesting that overdiagnosis may affect commonly diagnosed conditions such as attention-deficit/hyperactivity disorder, bacteremia, food allergy, hyperbilirubinemia, obstructive sleep apnea, and urinary tract infection. Through these and other examples, we discuss why overdiagnosis occurs and how it may be harming children. Additionally, we consider research and education strategies, with the goal to better elucidate pediatric overdiagnosis and mitigate its influence.
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Affiliation(s)
- Eric R Coon
- Division of Inpatient Medicine, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah;
| | - Ricardo A Quinonez
- Baylor College of Medicine, San Antonio Children's Hospital, San Antonio, Texas
| | - Virginia A Moyer
- American Board of Pediatrics, Maintenance of Certification and Quality, Chapel Hill, North Carolina; and
| | - Alan R Schroeder
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
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71
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Arakawa A, Oguma E, Aihara T, Kishimoto H, Kikuchi A, Hanada R, Koh K. Long-term follow-up results of the observation program for neuroblastoma detected at 6-month mass screening. J Pediatr 2014; 165:855-7.e1. [PMID: 25091258 DOI: 10.1016/j.jpeds.2014.06.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 05/02/2014] [Accepted: 06/24/2014] [Indexed: 11/25/2022]
Abstract
We conducted an observation program of neuroblastoma in infants, detected by mass screening at 6 months of age; we followed up with them for 15 years. No recurrence was observed after disappearance of tumors, and persistent tumors showed no malignant transformation or metastasis. Histology of the resected tumors showed age-related differentiation.
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Affiliation(s)
- Ayumu Arakawa
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan.
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Toshinori Aihara
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kishimoto
- Department of Pathology, Saitama Children's Medical Center, Saitama, Japan
| | - Akira Kikuchi
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Ryoji Hanada
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
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72
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Narod S. Reflections on screening mammography and the early detection of breast cancer: A Countercurrents Series. Curr Oncol 2014; 21:210-4. [PMID: 25301304 PMCID: PMC4189560 DOI: 10.3747/co.21.2068] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A little learning is a dangerous thing.[...]
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Affiliation(s)
- S.A. Narod
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON
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73
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Esserman LJ, Thompson IM, Reid B, Nelson P, Ransohoff DF, Welch HG, Hwang S, Berry DA, Kinzler KW, Black WC, Bissell M, Parnes H, Srivastava S. Addressing overdiagnosis and overtreatment in cancer: a prescription for change. Lancet Oncol 2014; 15:e234-42. [PMID: 24807866 DOI: 10.1016/s1470-2045(13)70598-9] [Citation(s) in RCA: 352] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A vast range of disorders--from indolent to fast-growing lesions--are labelled as cancer. Therefore, we believe that several changes should be made to the approach to cancer screening and care, such as use of new terminology for indolent and precancerous disorders. We propose the term indolent lesion of epithelial origin, or IDLE, for those lesions (currently labelled as cancers) and their precursors that are unlikely to cause harm if they are left untreated. Furthermore, precursors of cancer or high-risk disorders should not have the term cancer in them. The rationale for this change in approach is that indolent lesions with low malignant potential are common, and screening brings indolent lesions and their precursors to clinical attention, which leads to overdiagnosis and, if unrecognised, possible overtreatment. To minimise that potential, new strategies should be adopted to better define and manage IDLEs. Screening guidelines should be revised to lower the chance of detection of minimal-risk IDLEs and inconsequential cancers with the same energy traditionally used to increase the sensitivity of screening tests. Changing the terminology for some of the lesions currently referred to as cancer will allow physicians to shift medicolegal notions and perceived risk to reflect the evolving understanding of biology, be more judicious about when a biopsy should be done, and organise studies and registries that offer observation or less invasive approaches for indolent disease. Emphasis on avoidance of harm while assuring benefit will improve screening and treatment of patients and will be equally effective in the prevention of death from cancer.
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Affiliation(s)
| | - Ian M Thompson
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Brian Reid
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Peter Nelson
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | | | - Donald A Berry
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Mina Bissell
- Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Howard Parnes
- Division of Prostate and Urologic Cancer Research Group, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sudhir Srivastava
- Cancer Biomarkers Research Group, Division of Cancer Prevention, National Institutes of Health, Bethesda, MD, USA
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74
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Hisashige A. Effectiveness of nationwide screening program for neuroblastoma in Japan. Glob J Health Sci 2014; 6:94-106. [PMID: 25001552 PMCID: PMC4825238 DOI: 10.5539/gjhs.v6n4p94] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 03/20/2014] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Neuroblastoma (NB) is one of the most malignant neoplasms in childhood. In Japan, while a nationwide screening program at six months of age was introduced in 1985, its efficacy has not been systematically evaluated before or after its introduction. The screening test was changed from a qualitative method to a quantitative method (i.e., high performance liquid chromatography, HPLC) with higher test precision around 1990. However, the Japanese government stopped the program in 2003, after reports which did not show a reduction in mortality from NB. To evaluate the effectiveness of the program, a systematic large-scale epidemiological study was conducted. METHODS A retrospective cohort study was carried out to evaluate the effectiveness of the NB screening with HPLC test at 6 months of age in Japan, in comparing mortality and incidence of NB after 6 months of age between screened children and concurrent non-screened children in the same area. The study cohort was defined retrospectively as those children who were born after the introduction of HPLC test, from its earliest introduction of January 1984 to December 31, 1997, in twenty-five prefectures of Japan, which cover approximately half of the newborn population of Japan. RESULTS The study cohort consisted of 4.31 million. We identified 66 NB deaths in the study cohort for the analysis after 6 months. Kaplan-Meier estimate of cumulative mortality of NB per million children at 6 years was 15.33 for the screened group and 32.63 for the non-screened group, respectively. The difference of hazard between the two groups was statistically significant. The age specific mortality rate ratio of NB (95% confidence interval (CI)) was statistically lower at 1 - 3 years [0.415 (0.212 - 0.810)]. The rate ratio of NB incidence (95% CI) at the early stage (i.e., 1, 2 and 4S) between them was statistically higher at 6 months - 1 year [9.56 (4.76 - 19.23)]. That of NB incidence at the advanced stage (i.e., 3 and 4) was statistically lower at 1 - 4 years [0.40 (0.26 - 0.62)]. CONCLUSION The present study showed the reduction of mortality from NB, as well as the increase of the identification of early stage of NB and the decrease of advanced stage of NB. These findings strongly suggest the effectiveness of the NB screening with HPLC test in Japan. Although there could be several biases inherent to the study design, their possibilities are considered to be relatively low from observational information and theoretical consideration.
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Affiliation(s)
- Akinori Hisashige
- The Institute of Healthcare Technology Assessment, Tokushima, Japan.
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75
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Haruta M, Kamijo T, Nakagawara A, Kaneko Y. RASSF1A methylation may have two biological roles in neuroblastoma tumorigenesis depending on the ploidy status and age of patients. Cancer Lett 2014; 348:167-76. [PMID: 24680815 DOI: 10.1016/j.canlet.2014.03.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 03/19/2014] [Accepted: 03/19/2014] [Indexed: 12/27/2022]
Abstract
RASSF1A methylation was frequent in neuroblastomas found in infants by mass-screening or infants and children diagnosed clinically, whereas CASP8 and DCR2 methylation was only frequent in tumors in children. When classified according to the ploidy status, RASSF1A and PCDHB methylation was only associated with MYCN amplification and poor outcomes in infants with a clinically diagnosed diploid, not triploid tumor. RASSF1A and PCDHB methylation was associated with poor outcomes in children with triploid and diploid tumors, respectively, and with MYCN amplification in children with diploid tumor. RASSF1A methylation may have two biological roles based on the ploidy status and patient's age.
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Affiliation(s)
- Masayuki Haruta
- Research Institute for Clinical Oncology, Saitama Cancer Center, Ina, Saitama, Japan
| | | | | | - Yasuhiko Kaneko
- Research Institute for Clinical Oncology, Saitama Cancer Center, Ina, Saitama, Japan.
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76
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Long-term follow-up of the "wait and see" approach to localized perinatal adrenal neuroblastoma. World J Surg 2013; 37:459-65. [PMID: 23135423 DOI: 10.1007/s00268-012-1837-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Evidence-based guidelines for the management of localized perinatal adrenal neuroblastoma are not yet available. We describe our preliminary experience managing this tumor with a "wait and see" policy. METHODS A single-center prospective study (February 2002 to December 2009) was conducted with 12 consecutive patients in whom an adrenal mass was detected antenatally or within the first 3 months of life. Diagnostic workup included the following investigations: measurement of urine catecholamine metabolites, imaging studies (ultrasonography, magnetic resonance imaging, or computed tomography), metaiodobenzylguanidine scintigraphy, and/or core needle biopsy. RESULTS The male/female ratio was 1.4:1.0. Median tumor size at presentation was 29 mm (range 10-50 mm). Eight lesions were detected antenatally. Ten lesions were diagnosed as localized neuroblastoma. Of these ten lesions, four were excised because of parental preference (n = 2), tumor enlargement (n = 1) or tumor persistence (n = 1). The remaining six patients underwent watchful clinical observation, which showed progressive tumor shrinkage and complete regression within 10-39 months (median 12.5 months). The final two lesions were small predominantly cystic lesions without a clear-cut diagnosis. They were managed noninvasively. At an overall median follow-up of 109 months (range 30-122 months), all patients are alive and disease-free, although one patient progressed to stage 4 disease despite early excision of the primary tumor. CONCLUSIONS Spontaneous regression of localized perinatal adrenal neuroblastoma occurs often, and a "wait and see" strategy seems justified in these small infants. Patients with enlarging or stable lesions that have persisted for several months may benefit from surgery, although prompt excision may not prevent tumor progression.
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77
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Lantos JD. Dangerous and expensive screening and treatment for rare childhood diseases: the case of Krabbe disease. ACTA ACUST UNITED AC 2013; 17:15-8. [PMID: 22447750 DOI: 10.1002/ddrr.133] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Public policy surrounding newborn screening is in flux. New technology allows more screening for more diseases at lower cost. Traditional criteria for target diseases have been criticized by leading health policymakers. The example of newborn screening for Krabbe disease highlights many of the dilemmas associated with population-based screening programs. Krabbe is difficult to diagnose, variable in its natural history, and does not always respond to treatment. The only available treatment is hematopoietic stem cell transplantation, which is expensive, risky, and of uncertain efficacy. This article analyzes the debate about Krabbe as an example of the sorts of debates that will likely arise for many more diseases over the next decade. I conclude that pilot programs in pioneer states should be carefully evaluated before testing for Krabbe is universalized.
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Affiliation(s)
- John D Lantos
- Department of Pediatrics, University of Missouri, Kansas City, Missouri; Children's Mercy Bioethics Center, Children's Mercy Hospital, Kansas City 64108, Missouri.
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78
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Chakrabarti L, Abou-Antoun T, Vukmanovic S, Sandler AD. Reversible adaptive plasticity: a mechanism for neuroblastoma cell heterogeneity and chemo-resistance. Front Oncol 2012; 2:82. [PMID: 22891161 PMCID: PMC3412992 DOI: 10.3389/fonc.2012.00082] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 07/15/2012] [Indexed: 01/05/2023] Open
Abstract
We describe a novel form of tumor cell plasticity characterized by reversible adaptive plasticity in murine and human neuroblastoma. Two cellular phenotypes were defined by their ability to exhibit adhered, anchorage dependent (AD) or sphere forming, anchorage independent (AI) growth. The tumor cells could transition back and forth between the two phenotypes and the transition was dependent on the culture conditions. Both cell phenotypes exhibited stem-like features such as expression of nestin, self-renewal capacity, and mesenchymal differentiation potential. The AI tumorspheres were found to be more resistant to chemotherapy and proliferated slower in vitro compared to the AD cells. Identification of specific molecular markers like MAP2, β-catenin, and PDGFRβ enabled us to characterize and observe both phenotypes in established mouse tumors. Irrespective of the phenotype originally implanted in mice, tumors grown in vivo show phenotypic heterogeneity in molecular marker signatures and are indistinguishable in growth or histologic appearance. Similar molecular marker heterogeneity was demonstrated in primary human tumor specimens. Chemotherapy or growth factor receptor inhibition slowed tumor growth in mice and promoted initial loss of AD or AI heterogeneity, respectively. Simultaneous targeting of both phenotypes led to further tumor growth delay with emergence of new unique phenotypes. Our results demonstrate that neuroblastoma cells are plastic, dynamic, and may optimize their ability to survive by changing their phenotype. Phenotypic switching appears to be an adaptive mechanism to unfavorable selection pressure and could explain the phenotypic and functional heterogeneity of neuroblastoma.
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Affiliation(s)
- Lina Chakrabarti
- The Joseph E. Robert Center for Surgical Care, Children’s National Medical CenterWashington, DC, USA
- The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Medical CenterWashington, DC, USA
| | - Thamara Abou-Antoun
- The Joseph E. Robert Center for Surgical Care, Children’s National Medical CenterWashington, DC, USA
- The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Medical CenterWashington, DC, USA
| | - Stanislav Vukmanovic
- The Joseph E. Robert Center for Surgical Care, Children’s National Medical CenterWashington, DC, USA
- The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Medical CenterWashington, DC, USA
| | - Anthony D. Sandler
- The Joseph E. Robert Center for Surgical Care, Children’s National Medical CenterWashington, DC, USA
- The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Medical CenterWashington, DC, USA
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79
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Kroesen M, Lindau D, Hoogerbrugge P, Adema GJ. Immunocombination therapy for high-risk neuroblastoma. Immunotherapy 2012; 4:163-74. [PMID: 22394368 DOI: 10.2217/imt.11.169] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Neuroblastoma (NBL) is an aggressive malignancy of the sympathetic nervous system. Advanced-stage NBLs prove fatal in approximately 50% of patients within 5 years. Therefore, new treatment modalities are urgently needed. Immunotherapy is a treatment modality that can be combined with established forms of treatment. Administration of monoclonal antibodies or dendritic cell-based therapies alone can lead to favorable clinical outcomes in individual cancer patients; for example patients with melanoma, lymphoma and NBL. However, clinical benefit is still limited to a minority of patients, and further improvements are clearly needed. In this article, we review the most commonly used approaches to treat patients with NBL and highlight the prerequisites and opportunities of cell-based immunotherapy, involving both innate and adaptive immune-effector cells. Furthermore, we discuss the potential of the combined application of immunotherapy and novel tumor-targeted therapies for the treatment of both cancer in general and NBL in particular.
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Affiliation(s)
- Michiel Kroesen
- Department of Tumor Immunology, Nijmegen Centre for Molecular Life Sciences/278 TIL, 6500 HB Nijmegen, The Netherlands
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80
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Kuyama H, Nii A, Takehara H, Inoue N, Watanabe H, Sakaki M. Ganglioneuroblastoma, intermixed with opsoclonus-myoclonus syndrome. Pediatr Int 2012; 54:e26-8. [PMID: 22631586 DOI: 10.1111/j.1442-200x.2012.03597.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hisako Kuyama
- Department of Pediatric Surgery, Tokushima University Hospital, Tokushima, Japan.
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81
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Pediatric malignancies: neuroblastoma, Wilm's tumor, hepatoblastoma, rhabdomyosarcoma, and sacroccygeal teratoma. Surg Clin North Am 2012; 92:745-67, x. [PMID: 22595719 DOI: 10.1016/j.suc.2012.03.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Common pediatric malignancies are reviewed: neuroblastoma, Wilms tumor, hepatoblastoma, rhabdomyosarcoma, and sacrococcygeal teratoma. Elements of presentation, diagnosis, staging, treatment, and longterm prognosis are discussed, with particular attention to surgical management.
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82
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Kawada T. Trend in the Number of Registrations for Neuroblastoma in Japan. Jpn J Clin Oncol 2012; 42:357-8. [DOI: 10.1093/jjco/hys013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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83
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Sartelet H, Imbriglio T, Nyalendo C, Haddad E, Annabi B, Duval M, Fetni R, Victor K, Alexendrov L, Sinnett D, Fabre M, Vassal G. CD133 expression is associated with poor outcome in neuroblastoma via chemoresistance mediated by the AKT pathway. Histopathology 2012; 60:1144-55. [PMID: 22394107 DOI: 10.1111/j.1365-2559.2012.04191.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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84
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Sun W, Modak S. Emerging treatment options for the treatment of neuroblastoma: potential role of perifosine. Onco Targets Ther 2012; 5:21-9. [PMID: 22419878 PMCID: PMC3299554 DOI: 10.2147/ott.s14578] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Achieving a cure for high-risk neuroblastoma, the most common extracranial solid tumor in children, remains a formidable task despite the recent addition of antibody-mediated anti-GD2 immunotherapy to established multimodality therapy. The PI3K/Akt pathway is a pivotal signaling pathway utilized by a plethora of receptor tyrosine kinases that contribute to the aggressive phenotype of high-risk neuroblastoma. Akt is aberrantly activated in high-risk neuroblastoma and is therefore an attractive therapeutic target. Perifosine is the best-characterized Akt inhibitor in preclinical studies and in clinical trials in adults, although safety in children is not yet confirmed. It is a synthetic third-generation alkylphospholipid with good oral bioavailability and modest side effects. Perifosine targets the lipid-binding PH domain of Akt and inhibits the translocation of Akt to the cell membrane, an essential step for Akt activation. It decreases Akt phosphorylation and increases caspase-dependent apoptosis in neuroblastoma cell lines, inhibits growth of neuroblastoma xenografts, and overcomes RTK/ligand-mediated chemoresistance. It is currently being studied in two Phase I clinical trials in children with recurrent or refractory solid tumors including neuroblastoma. In the single agent trial (ClinicalTrials.gov identifier NCT00776867), maximum tolerated dose has not yet been reached and pharmacokinetic data has been accrued. In the second study (ClinicalTrials.gov identifier NCT01049841), patients are treated with a combination of perifosine and the mTOR-inhibitor temsirolimus based on preclinical data showing synergy of the two agents, and the premise that direct Akt inhibition may overcome Akt activation secondary to mTOR inhibition. Based on results from adult trials, it is unlikely that perifosine alone will produce dramatic therapeutic effects against high-risk neuroblastoma. However, given the recent encouraging early-phase combination therapy results in adults with multiple myeloma and colorectal carcinoma, rational perifosine-containing combination regimens hold promise for neuroblastoma therapy. These will be explored after safety in children is established in Phase I studies.
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Affiliation(s)
- Weili Sun
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Children's Hospital of Los Angeles, Los Angeles, CA, USA
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85
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Habib EE, El-Kashef AT, Fahmy ES. Management of neuroblastoma: a study of first- and second-line chemotherapy responses, a single institution experience. Oncol Rev 2012; 6:e3. [PMID: 25992205 PMCID: PMC4419637 DOI: 10.4081/oncol.2012.e3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 01/20/2012] [Accepted: 02/03/2012] [Indexed: 11/23/2022] Open
Abstract
Neuroblastoma is a high-grade malignancy of childhood. It is chemo- and radio-sensitive but prone to relapse after initial remission. The aim of the current study was to study the results of the first- and second-line chemotherapy on the short-term response and long-term survival of children, and to further describe the side effects of treatment. Ninety-five children with advanced neuroblastoma were included in the study, divided into two groups according to the treatment strategy: 65 were treated by first-line chemotherapy alone, and 30 children who were not responding or relapsed after first-line chemotherapy were treated by second-line chemotherapy. External beam radiotherapy was given to bone and brain secondary cancers when detected. Staging workup was performed before, during and after management. Response was documented after surgery for the primary tumor. Median follow up was 32 months (range 24–60 months). Chemothe rapy was continued until toxicity or disease progression occurred, indicating interruption of chemotherapy. Patients received a maximum of 8 cycles. Toxicity was mainly myelo-suppression, with grade II-III severity in 60% of the firstline and 70% of the second-line chemotherapy patients. Median total actuarial survival was nearly 51 months for the first-line chemotherapy group and 30 months for the second-line line group, with a statistically significant difference between the two groups (P<0.01).
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Affiliation(s)
- Emmad E Habib
- Clinical Oncology Department, Faculty of Medicine, Cairo University, Egypt
| | - Amr T El-Kashef
- Clinical Oncology Department, Faculty of Medicine, Cairo University, Egypt
| | - Ezzat S Fahmy
- Clinical Oncology Department, Faculty of Medicine, Cairo University, Egypt
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86
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Clinical significance of serum biomarkers in pediatric solid mediastinal and abdominal tumors. Int J Mol Sci 2012; 13:1126-1153. [PMID: 22312308 PMCID: PMC3269742 DOI: 10.3390/ijms13011126] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 01/01/2012] [Accepted: 01/16/2012] [Indexed: 02/07/2023] Open
Abstract
Childhood cancer is the leading cause of death by disease among U.S. children between infancy and age 15. Despite successes in treating solid tumors such as Wilms tumor, disappointments in the outcomes of high-risk solid tumors like neuroblastoma have precipitated efforts towards the early and accurate detection of these malignancies. This review summarizes available solid tumor serum biomarkers with a special focus on mediastinal and abdominal cancers in children.
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87
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Schmitt J, Keller A, Nourkami-Tutdibi N, Heisel S, Habel N, Leidinger P, Ludwig N, Gessler M, Graf N, Berthold F, Lenhof HP, Meese E. Autoantibody signature differentiates Wilms tumor patients from neuroblastoma patients. PLoS One 2011; 6:e28951. [PMID: 22194956 PMCID: PMC3241697 DOI: 10.1371/journal.pone.0028951] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 11/17/2011] [Indexed: 11/19/2022] Open
Abstract
Several studies report autoantibody signatures in cancer. The majority of these studies analyzed adult tumors and compared the seroreactivity pattern of tumor patients with the pattern in healthy controls. Here, we compared the autoimmune response in patients with neuroblastoma and patients with Wilms tumor representing two different childhood tumors. We were able to differentiate untreated neuroblastoma patients from untreated Wilms tumor patients with an accuracy of 86.8%, a sensitivity of 87.0% and a specificity of 86.7%. The separation of treated neuroblastoma patients from treated Wilms tumor patients' yielded comparable results with an accuracy of 83.8%. We furthermore identified the antigens that contribute most to the differentiation between both tumor types. The analysis of these antigens revealed that neuroblastoma was considerably more immunogenic than Wilms tumor. The reported antigens have not been found to be relevant for comparative analyses between other tumors and controls. In summary, neuroblastoma appears as a highly immunogenic tumor as demonstrated by the extended number of antigens that separate this tumor from Wilms tumor.
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Affiliation(s)
- Jana Schmitt
- Department of Human Genetics, Medical School, Saarland University, Homburg, Germany.
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88
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Perwein T, Lackner H, Sovinz P, Benesch M, Schmidt S, Schwinger W, Urban C. Survival and late effects in children with stage 4 neuroblastoma. Pediatr Blood Cancer 2011; 57:629-35. [PMID: 21319289 DOI: 10.1002/pbc.23036] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 12/21/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND Treatment of metastatic neuroblastoma (NB) demands aggressive oncological therapy, which may cause long-term sequelae in survivors. The aim of this retrospective single center study is to give an overview of survival in children with stage 4 NB and to describe the spectrum of late effects seen in survivors. PROCEDURE Medical records of 31 patients with stage 4 NB treated between 1984 and 2009, who were included in a follow-up programme, were reviewed for information on tumor, treatment and late effects. RESULTS Five-year overall survival was 54.3 ± 9% and 5-year event-free survival was 44.9 ± 9%. Patients diagnosed after 1996 had a significantly better survival rate than those diagnosed before (74 ± 11.2% vs. 33.3 ± 12.2%, P = 0.011). In 15 of the 16 survivors (93.8%), numerous late effects were detected. The most common long-term sequelae were renal changes in 10 patients (62.5%) and endocrine disturbances in 9 patients (56.3%), including hypothyroidism with need of substitution in 50%, GH deficiency in 37.5% and hypogonadism in 12.5%. Sensorineural hearing loss occurred in 37.5% of survivors. Further observed late effects were hepatobiliary changes (31.3%), musculoskeletal problems, and pulmonary abnormalities (each 25%), as well as neurologic changes (18.8%), dental defects (12.5%), and unilateral blindness (6.3%). Second neoplasms appeared in 3 patients, 1 of whom died of hepatocellular carcinoma following infection with hepatitis B. CONCLUSIONS More than 50% of children with stage 4 NB may survive. The high incidence of severe long-term sequelae underlines the importance of careful follow-up in order to detect and treat late effects early enough.
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Affiliation(s)
- Thomas Perwein
- Division of Paediatric Haematology/Oncology, Medical University of Graz, Graz, Austria.
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89
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Kostyrka B, Li J, Soundappan SV, Cassey J, Alvaro F, Dalla Pozza L, Kumar R. Features and outcomes of neonatal neuroblastoma. Pediatr Surg Int 2011; 27:937-41. [PMID: 21710243 DOI: 10.1007/s00383-011-2937-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Neonatal neuroblastoma (NNBL) is a rare tumour with few reported cases in the literature. The prognosis of NNBL is unclear with reported survival between 76 and 91%. The growing use of ante-natal ultrasound (USS) in recent years has resulted in an increasing incidence of NNBL. The purpose of this study is to review our experience with incidence, clinical features and outcome of NNBL in those children diagnosed ante-natally compared to those diagnosed post-natally. METHODS Twelve cases of NNBL were detected ante-natally or in the neonatal period (0-28 days) from a cohort of 120 children diagnosed with neuroblastoma (10%) over a 10-year period at the study institutions. Review of these 12 children forms the basis of this report. RESULTS Ante-natal diagnosis (ADNB) was made in six children (50%) and post-natal diagnosis (PDNB) in six (50%). Tumour site in both cohorts were predominantly adrenal and tumour staging was similar in both groups. There was no difference in outcome in ADNB compared to PDNB with overall 100% survival for the entire group. CONCLUSIONS NNBL is a subset of neuroblastoma with apparent excellent outcome irrespective of the time of diagnosis. Clinical features and outcomes of ADNB are no different to PDNB.
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Affiliation(s)
- B Kostyrka
- Department of Paediatric Surgery, John Hunter Children's Hospital, Hunter Region Mail Centre, Newcastle, NSW, Australia
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90
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Abstract
Innovative 'systems' approaches to biomedical research offer substantial promise for advancing knowledge and improving health care, as outlined by Bousquet et al. in this issue. However, they are unlikely to improve population health without concurrent efforts to address environmental and social contributors to health, including conditions such as poverty, substandard housing, and restricted access to employment and education. Biomedical researchers have a responsibility to promote realistic expectations for systems or 'P4' medicine, and to join others in calling for broad efforts to promote equitable access to health care and social conditions that promote well-being.See correspondence article: http://genomemedicine.com/content/3/7/43.
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Affiliation(s)
- Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Box 357120, 1959 NE Pacific, Room A204, Seattle, WA 98195-7120, USA.
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91
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92
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Savage WJ, Everett AD. Biomarkers in pediatrics: Children as biomarker orphans. Proteomics Clin Appl 2010; 4:915-21. [DOI: 10.1002/prca.201000062] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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93
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Affiliation(s)
- Sunita Dhir
- Department of Paediatric Haematology and Oncology, Oxford Children's Hospital, Oxford, OX3 9DU, United Kingdom
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94
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Wilcken B. Expanded newborn screening: reducing harm, assessing benefit. J Inherit Metab Dis 2010; 33:S205-10. [PMID: 20440650 DOI: 10.1007/s10545-010-9106-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 03/28/2010] [Accepted: 04/01/2010] [Indexed: 12/30/2022]
Abstract
Achieving the goals of newborn screening is, as for any screening, a balancing act: getting the maximum benefit from screening while producing the minimum harm. The advent of "expanded" newborn screening, with a large number of disorders detectable using a single test, has also posed problems, not new, but now more obvious. One is the finding of many more cases by screening, the extra cases being largely patients who have attenuated phenotypes and may remain asymptomatic for many years, even throughout life. These may or may not require active management in the short term, but do need lifelong awareness. Additionally, disorders have been included that are now thought benign or largely so. Babies risk being unnecessarily medicalized. Assessing outcome has also proved difficult because of the rarity of some disorders and the impracticality of randomized controlled trials. The requirements for valid studies include the need for case definitions, comparable comparison groups and probably assessment on a whole-population basis. An Australia-wide study of tandem mass spectrometry newborn screening involving 2 million screened and unscreened babies has demonstrated benefits overall to screened patients at age 6 years. The study was too small to provide conclusions for individual disorders other than for medium-chain acyl-CoA dehydrogenase deficiency.
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Affiliation(s)
- Bridget Wilcken
- Biochemical Genetics and Newborn Screening, The Children's Hospital at Westmead, Hawkesbury Road, Westmead, NSW, Australia.
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95
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Smith SJ, Diehl NN, Smith BD, Mohney BG. Urine catecholamine levels as diagnostic markers for neuroblastoma in a defined population: implications for ophthalmic practice. Eye (Lond) 2010; 24:1792-6. [PMID: 20865029 DOI: 10.1038/eye.2010.125] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE although elevated urinary catecholamine levels have been reported in 90-95% of patients with neuroblastoma, more recent studies of pediatric Horner syndrome caused by an underling neuroblastoma have reported normal values at presentation. The purpose of this population-based study is to report the percentage of cases of neuroblastoma with elevated urinary catecholamine levels at presentation and to suggest a recommended work-up for cases of idiopathic pediatric Horner syndrome. METHODS the medical records of all pediatric (<19 years) residents of Olmsted County, Minnesota diagnosed with neuroblastoma from 1 January 1969 through 31 December 2008 were retrospectively reviewed. RESULTS a total of 14 patients <19 years of age were diagnosed with neuroblastoma as residents of Olmsted County, Minnesota, during the 40-year study period. A total of 10 (71%) of the 14 cases manifested elevated urinary catecholamine metabolites at the initial presentation. Urinary vanillylmandelic acid (VMA) levels were greater than twice the upper limit of normal in eight (57%) of 14 cases, whereas homovanillic acid (HVA) levels were greater than two times the upper limit of normal in 10 (71%) of the 14 cases. Three (75%) of the four cases without significantly elevated urinary VMA or HVA levels were diagnosed with stage IV disease, whereas one (25%) had stage II neuroblastoma. CONCLUSION urinary catecholamine levels were significantly elevated at presentation in 10 (71%) of the 14 neuroblastoma cases during the 40-year study period, suggesting that greater emphasis be placed on performing a thorough physical examination and obtaining warranted imaging studies in cases of idiopathic pediatric Horner syndrome.
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Affiliation(s)
- S J Smith
- Mayo Clinic College of Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
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96
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Abstract
IMPORTANCE OF THE FIELD Neuroblastoma, a tumor of the sympathetic nervous system, is the most common extracranial solid tumor of early life. High risk disease in older children remains a therapeutic challenge, despite high-intensity therapy with correspondingly significant short- and long-term toxicities. AREAS COVERED IN THIS REVIEW We have reviewed therapy for neuroblastoma over the last three decades. This includes cytotoxic chemotherapy, immunotherapy, radionuclides, antiangiogenic compounds, and molecularly targeted agents. We provide a perspective on the incorporation of these drugs into therapy for neuroblastoma. WHAT THE READER WILL GAIN The reader will gain a better understanding of these novel agents and their targets in neuroblastoma. The reader will also gain insight into the need to define through sequential, carefully designed clinical trials, the roles and toxicities of these therapies, especially if the combination of targeted and conventional cytotoxic agents is used. TAKE HOME MESSAGE Advanced-stage neuroblastoma in older infants and children remains a disease that is difficult to cure. New, targeted agents may improve both the therapeutic index and the outcome, but are, for the most part, in early development and present a challenge for clinical trial design given both the rarity of this disease and its responsiveness (albeit incomplete) to currently used cytotoxic agents.
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Affiliation(s)
- Rani E George
- Dana-Faber Cancer Institute, Department of Pediatric Oncology, Boston, MA, USA
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97
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Sartelet H, Ohta S, Barrette S, Rougemont AL, Brevet M, Regairaz M, Harvey I, Bernard C, Fabre M, Gaboury L, Oligny LL, Bosq J, Valteau-Couanet D, Vassal G. High level of apoptosis and low AKT activation in mass screening as opposed to standard neuroblastoma. Histopathology 2010; 56:607-16. [PMID: 20459571 DOI: 10.1111/j.1365-2559.2010.03522.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS Neuroblastoma is a paediatric solid tumour with a poor outcome except in children <1 year old. Based on catecholamine urinary excretion, mass screening (MS) programmes have been organized but failed to decrease the mortality of this tumour. To test the hypotheses of a spontaneous maturation/differentiation or regression, the levels of poly (ADP-ribose) polymerase (PARP)-1, an early apoptosis marker, of PhosphoAKT, a major apoptosis inhibitor, and of maturation/differentiation were compared in standard and in MS neuroblastomas. METHODS AND RESULTS We performed a case-control study of 55 primary tumours and 21 metastases of MS neuroblastomas. Matched controls were standard unscreened neuroblastomas and were paired according to age, stage, and MYCN amplification. The tumours were included in tissue microarrays. Immunohistochemical staining was performed using antibodies against, AKT, phosphoAKT, TRKB and PARP-1. The expression of PARP-1 and that of phosphoAKT were significantly higher in standard than in MS neuroblastomas independently of age and stage of the tumour. PhosphoAKT and PARP-1 expression was significantly correlated in both tumours. CONCLUSIONS These data suggest that the better prognosis of patients with MS neuroblastomas compared with classical neuroblastomas was secondary to spontaneous tumour regression mediated by higher levels of apoptosis associated with low activation of AKT.
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Affiliation(s)
- Hervé Sartelet
- Department of Pathology, CHU Sainte Justine Montreal, Montreal, Quebec, Canada.
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98
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Lauer MS. Screening asymptomatic subjects for subclinical atherosclerosis: not so obvious. J Am Coll Cardiol 2010; 56:106-8. [PMID: 20620725 DOI: 10.1016/j.jacc.2010.01.059] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 01/11/2010] [Indexed: 11/16/2022]
Affiliation(s)
- Michael S Lauer
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892, USA.
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Oberthuer A, Hero B, Berthold F, Juraeva D, Faldum A, Kahlert Y, Asgharzadeh S, Seeger R, Scaruffi P, Tonini GP, Janoueix-Lerosey I, Delattre O, Schleiermacher G, Vandesompele J, Vermeulen J, Speleman F, Noguera R, Piqueras M, Bénard J, Valent A, Avigad S, Yaniv I, Weber A, Christiansen H, Grundy RG, Schardt K, Schwab M, Eils R, Warnat P, Kaderali L, Simon T, Decarolis B, Theissen J, Westermann F, Brors B, Fischer M. Prognostic impact of gene expression-based classification for neuroblastoma. J Clin Oncol 2010; 28:3506-15. [PMID: 20567016 DOI: 10.1200/jco.2009.27.3367] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the impact of a predefined gene expression-based classifier for clinical risk estimation and cytotoxic treatment decision making in neuroblastoma patients. PATIENTS AND METHODS Gene expression profiles of 440 internationally collected neuroblastoma specimens were investigated by microarray analysis, 125 of which were examined prospectively. Patients were classified as either favorable or unfavorable by a 144-gene prediction analysis for microarrays (PAM) classifier established previously on a separate set of 77 patients. PAM classification results were compared with those of current prognostic markers and risk estimation strategies. RESULTS The PAM classifier reliably distinguished patients with contrasting clinical courses (favorable [n = 249] and unfavorable [n = 191]; 5-year event free survival [EFS] 0.84 +/- 0.03 v 0.38 +/- 0.04; 5-year overall survival [OS] 0.98 +/- 0.01 v 0.56 +/- 0.05, respectively; both P < .001). Moreover, patients with divergent outcome were robustly discriminated in both German and international cohorts and in prospectively analyzed samples (P <or= .001 for both EFS and OS for each). In subgroups with clinical low-, intermediate-, and high-risk of death from disease, the PAM predictor significantly separated patients with divergent outcome (low-risk 5-year OS: 1.0 v 0.75 +/- 0.10, P < .001; intermediate-risk: 1.0 v 0.82 +/- 0.08, P = .042; and high-risk: 0.81 +/- 0.08 v 0.43 +/- 0.05, P = .001). In multivariate Cox regression models based on both EFS and OS, PAM was a significant independent prognostic marker (EFS: hazard ratio [HR], 3.375; 95% CI, 2.075 to 5.492; P < .001; OS: HR, 11.119, 95% CI, 2.487 to 49.701; P < .001). The highest potential clinical impact of the classifier was observed in patients currently considered as non-high-risk (n = 289; 5-year EFS: 0.87 +/- 0.02 v 0.44 +/- 0.07; 5-year OS: 1.0 v 0.80 +/- 0.06; both P < .001). CONCLUSION Gene expression-based classification using the 144-gene PAM predictor can contribute to improved treatment stratification of neuroblastoma patients.
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100
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Schleiermacher G, Janoueix-Lerosey I, Ribeiro A, Klijanienko J, Couturier J, Pierron G, Mosseri V, Valent A, Auger N, Plantaz D, Rubie H, Valteau-Couanet D, Bourdeaut F, Combaret V, Bergeron C, Michon J, Delattre O. Accumulation of segmental alterations determines progression in neuroblastoma. J Clin Oncol 2010; 28:3122-30. [PMID: 20516441 DOI: 10.1200/jco.2009.26.7955] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Neuroblastoma is characterized by two distinct types of genetic profiles, consisting of either numerical or segmental chromosome alterations. The latter are associated with a higher risk of relapse, even when occurring together with numerical alterations. We explored the role of segmental alterations in tumor progression and the possibility of evolution from indolent to aggressive genomic types. PATIENTS AND METHODS Array-based comparative genomic hybridization data of 394 neuroblastoma samples were analyzed and linked to clinical data. RESULTS Integration of ploidy and genomic data indicated that pseudotriploid tumors with mixed numerical and segmental profiles may be derived from pseudotriploid tumors with numerical alterations only. This was confirmed by the analysis of paired samples, at diagnosis and at relapse, as in tumors with a purely numerical profile at diagnosis additional segmental alterations at relapse were frequently observed. New segmental alterations at relapse were also seen in patients with segmental alterations at diagnosis. This was not linked to secondary effects of cytotoxic treatments since it occurred even in patients treated with surgery alone. A higher number of chromosome breakpoints were correlated with advanced age at diagnosis, advanced stage of disease, with a higher risk of relapse, and a poorer outcome. CONCLUSION These data provide further evidence of the role of segmental alterations, suggesting that tumor progression is linked to the accumulation of segmental alterations in neuroblastoma. This possibility of genomic evolution should be taken into account in treatment strategies of low- and intermediate-risk neuroblastoma and should warrant biologic reinvestigation at the time of relapse.
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Affiliation(s)
- Gudrun Schleiermacher
- L'Institut National de la Santé et de la Recherche Médicale U830, Institut Curie, 26 rue d'Ulm, 75248 Paris Cedex 05, France
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