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Pujol Manresa A, Buendía López S, Andión M, Herrero B, Lassaletta Á, Ramirez M, Ruano D, Hernández-Marqués C, Varo A, de Rojas T, Cortés Hernández M, Verdú-Amorós J, Martín Prado S, Artigas A, Redondo E, Ruiz Pato J, Herreros López P, Sevilla J, Madero L, Moreno L, Bautista Sirvent F, Rubio-San-Simón A. Safety and outcome of children, adolescents and young adults participating in phase I/II clinical oncology trials: a 9-year center experience. Front Pediatr 2024; 12:1423484. [PMID: 39318620 PMCID: PMC11421171 DOI: 10.3389/fped.2024.1423484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 08/13/2024] [Indexed: 09/26/2024] Open
Abstract
Introduction Enrolling children with cancer in early phase trials is crucial to access innovative treatments, contributing to advancing pediatric oncology research and providing tailored therapeutic options. Our objective is to analyze the impact of these trials on patient outcomes and safety, and to examine the evolution and feasibility of trials in pediatric cancer over the past decade. Methods All patients recruited in pediatric anticancer phase I/II clinical trials from January 2014 to December 2022 were included. Clinical records and trial protocols were analyzed. Results A total of 215 patients (median age 11.2 years, range 1-29.5) were included in 52 trials (258 inclusions). Patients with extracranial solid tumors (67%), central nervous system (CNS) tumors (24%), and leukemia (9%) were included. The most common investigational drugs were small molecules (28.3%) and antibodies (20.5%). Serious adverse events were experienced by 41% of patients, 4.4% discontinued treatment because of toxicity and two had toxic deaths. Median event-free survival was 3.7 months (95%CI: 2.8-4.5), longer in phase II trials than in phase I (2 vs. 6.3 months; p ≤ 0.001). Median overall survival was 12 months (95%CI: 9-15), higher in target-specific vs. non-target-specific trials (14 vs. 6 months; p ≤ 0.001). Discussion A significant and increasing number of patients have been included in early clinical trials, suggesting that both oncologists and families consider it valuable to be referred to specialized Units to access new therapies. Moreover, our data suggests that participation in early clinical trials, although not without potential toxicities, might have a positive impact on individual outcomes.
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Affiliation(s)
- Anna Pujol Manresa
- Pediatric Hematology-Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Division of Pediatric Hematology and Oncology, Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | - Susana Buendía López
- Pediatric Hematology-Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Maitane Andión
- Pediatric Hematology-Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- La Princesa Institute of Health, Madrid, Spain
| | - Blanca Herrero
- Pediatric Hematology-Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- La Princesa Institute of Health, Madrid, Spain
| | - Álvaro Lassaletta
- Pediatric Hematology-Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Manuel Ramirez
- Pediatric Hematology-Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- La Princesa Institute of Health, Madrid, Spain
| | - David Ruano
- Pediatric Hematology-Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- La Princesa Institute of Health, Madrid, Spain
| | - Carmen Hernández-Marqués
- Pediatric Hematology-Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Amalia Varo
- Pediatric Hematology-Oncology Department, Pediatric Cancer Center Barcelona, Barcelona, Spain
| | | | - Marta Cortés Hernández
- Pediatric Hematology-Oncology Department, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Jaime Verdú-Amorós
- Pediatric Hematology-Oncology Department, Hospital Clínico Universitario, Valencia, Spain
- Biomedical Research Institute, INCLIVA, Valencia, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Silvia Martín Prado
- Pharmacy Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Andrea Artigas
- Pediatric Hematology-Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Esther Redondo
- Pediatric Hematology-Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Julia Ruiz Pato
- Pediatric Hematology-Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Pilar Herreros López
- Pediatric Hematology-Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Julián Sevilla
- Pediatric Hematology-Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Luis Madero
- Pediatric Hematology-Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- La Princesa Institute of Health, Madrid, Spain
| | - Lucas Moreno
- Division of Pediatric Hematology and Oncology, Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | - Francisco Bautista Sirvent
- Pediatric Hematology-Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Trial and Data Centrum, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Alba Rubio-San-Simón
- Pediatric Hematology-Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- La Princesa Institute of Health, Madrid, Spain
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Juan-Ribelles A, Bautista F, Cañete A, Rubio-San-Simón A, Alonso-Saladrigues A, Hladun R, Rives S, Dapena JL, Fernández JM, Lassaletta Á, Cruz O, Ramírez-Villar G, Fuster JL, de Heredia CD, García-Ariza M, Quiroga E, Del Mar Andrés M, Verdú-Amorós J, Molinés A, Herrero B, López M, Márquez C, Toboso M, Lendínez F, Sirvent JG, Tallón M, Rodríguez G, Acha T, Moreno L, Fernández-Teijeiro A. ECLIM-SEHOP: how to develop a platform to conduct academic trials for childhood cancer. Clin Transl Oncol 2024; 26:2351-2359. [PMID: 38600340 PMCID: PMC11333546 DOI: 10.1007/s12094-024-03445-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/04/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION ECLIM-SEHOP platform was created in 2017. Its main objective is to establish the infrastructure to allow Spanish participation into international academic collaborative clinical trials, observational studies, and registries in pediatric oncology. The aim of this manuscript is to describe the activity conducted by ECLIM-SEHOP since its creation. METHODS The platform's database was queried to provide an overview of the studies integrally and partially supported by the organization. Data on trial recruitment and set-up/conduct metrics since its creation until November 2023 were extracted. RESULTS ECLIM-SEHOP has supported 47 studies: 29 clinical trials and 18 observational studies/registries that have recruited a total of 5250 patients. Integral support has been given to 25 studies: 16 trials recruiting 584 patients and nine observational studies/registries recruiting 278 patients. The trials include front-line studies for leukemia, lymphoma, brain and solid extracranial tumors, and other key transversal topics such as off-label use of targeted therapies and survivorship. The mean time from regulatory authority submission to first patient recruited was 12.2 months and from first international site open to first Spanish site open was 31.3 months. DISCUSSION ECLIM-SEHOP platform has remarkably improved the availability and accessibility of international academic clinical trials and has facilitated the centralization of resources in childhood cancer treatment. Despite the progressive improvement on clinical trial set-up metrics, timings should still be improved. The program has contributed to leveling survival rates in Spain with those of other European countries that presented major differences in the past.
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Affiliation(s)
- Antonio Juan-Ribelles
- Pediatric Oncology and Hematology Unit, Hospital Universitari y Politécnic La Fe, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | | | - Adela Cañete
- Pediatric Oncology and Hematology Unit, Hospital Universitari y Politécnic La Fe, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | - Alba Rubio-San-Simón
- Pediatric Oncology, Hematology and Stem Cell Transplant Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Anna Alonso-Saladrigues
- Pediatric Cancer Center Barcelona (PCCB), Hospital Sant Joan de Déu, Institut de Recerca San Joan de Déu (IRSJD), Barcelona, Spain
| | - Raquel Hladun
- Division of Pediatric Hematology and Oncology, Vall d'Hebron Comprehensive Cancer Center, Hospital Universitari Vall d'Hebrón, Passeig Vall d'Hebron 119, 08172, Barcelona, Spain
| | - Susana Rives
- Pediatric Cancer Center Barcelona (PCCB), Hospital Sant Joan de Déu, Institut de Recerca San Joan de Déu (IRSJD), Barcelona, Spain
| | - Jose Luís Dapena
- Pediatric Cancer Center Barcelona (PCCB), Hospital Sant Joan de Déu, Institut de Recerca San Joan de Déu (IRSJD), Barcelona, Spain
| | - Jose María Fernández
- Pediatric Oncology and Hematology Unit, Hospital Universitari y Politécnic La Fe, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | - Álvaro Lassaletta
- Pediatric Oncology, Hematology and Stem Cell Transplant Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Ofelia Cruz
- Pediatric Cancer Center Barcelona (PCCB), Hospital Sant Joan de Déu, Institut de Recerca San Joan de Déu (IRSJD), Barcelona, Spain
| | - Gemma Ramírez-Villar
- Department of Pediatric Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Jose Luís Fuster
- Hospital Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Cristina Diaz de Heredia
- Division of Pediatric Hematology and Oncology, Vall d'Hebron Comprehensive Cancer Center, Hospital Universitari Vall d'Hebrón, Passeig Vall d'Hebron 119, 08172, Barcelona, Spain
| | - Miguel García-Ariza
- Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Osakidetza, Barakaldo, Bizkaia, Spain
| | - Eduardo Quiroga
- Department of Pediatric Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - María Del Mar Andrés
- Pediatric Oncology and Hematology Unit, Hospital Universitari y Politécnic La Fe, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | - Jaime Verdú-Amorós
- INCLIVA - Biomedical Research Institute, Hospital Clínico Universitario, Valencia, Spain
| | - Antonio Molinés
- Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Blanca Herrero
- Pediatric Oncology, Hematology and Stem Cell Transplant Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Mónica López
- Hematology Department, University Hospital Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Catalina Márquez
- Department of Pediatric Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - María Toboso
- Pediatric Oncology and Hematology Unit, Hospital Universitari y Politécnic La Fe, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain
| | - Frencisco Lendínez
- Unidad de Oncohematologia Pediatrica. Hospital Infantil Universitario Torrecárdenas, Almeria, Spain
| | - Jose Gómez Sirvent
- Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Guiomar Rodríguez
- Sofpromed, CRO para ensayos clínicos en España, Palma de Mallorca, Spain
| | - Tomás Acha
- Unidad de Oncología Pediátrica, Hospital Materno-Infantil Carlos Haya, Málaga, Spain
| | - Lucas Moreno
- Division of Pediatric Hematology and Oncology, Vall d'Hebron Comprehensive Cancer Center, Hospital Universitari Vall d'Hebrón, Passeig Vall d'Hebron 119, 08172, Barcelona, Spain.
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Geoerger B, Bautista F, André N, Berlanga P, Gatz SA, Marshall LV, Rubino J, Archambaud B, Marchais A, Rubio-San-Simón A, Ducassou S, Zwaan CM, Casanova M, Nysom K, Pellegrino S, Hoog-Labouret N, Buzyn A, Blanc P, Paoletti X, Vassal G. Precision cancer medicine platform trials: Concepts and design of AcSé-ESMART. Eur J Cancer 2024; 208:114201. [PMID: 39018630 DOI: 10.1016/j.ejca.2024.114201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/23/2024] [Accepted: 06/27/2024] [Indexed: 07/19/2024]
Abstract
Precision cancer medicine brought the promise of improving outcomes for patients with cancer. High-throughput molecular profiling of tumors at treatment failure aims to direct a patient to a treatment matched to the tumor profile. In this way, improved outcome has been achieved in a small number of patients whose tumors exhibit unique targetable oncogenic drivers. Most cancers, however, contain multiple genetic alterations belonging to and of various hallmarks of cancer; for most of these alterations, there is limited knowledge on the level of evidence, their hierarchical roles in oncogenicity, and utility as biomarkers for response to targeted treatment(s). We developed a proof-of-concept trial that explores new treatment strategies in a molecularly-enriched tumor-agnostic, pediatric population. The evaluation of novel agents, including first-in-child molecules, alone or in combination, is guided by the available understanding of or hypotheses for the mechanisms of action of the diverse cancer events. Main objectives are: to determine 1) recommended phase 2 doses, 2) activity signals to provide the basis for disease specific development, and 3) to define new predictive biomarkers. Here we outline concepts, rationales and designs applied in the European AcSé-ESMART trial and highlight the feasibility but also complexity and challenges of such innovative platform trials.
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Affiliation(s)
- Birgit Geoerger
- Gustave Roussy Cancer Campus, Department of Pediatric and Adolescent Oncology, Université Paris-Saclay, Villejuif, France; Gustave Roussy Cancer Campus, INSERM U1015, Université Paris-Saclay, Villejuif, France.
| | - Francisco Bautista
- Hospital Niño Jesús, Department of Pediatric Oncology, Hematology and Stem Cell Transplantation, Madrid, Spain; Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Nicolas André
- Hôpital de la Timone, Department of Pediatric Oncology, AP-HM, Marseille, France; UMR INSERM 1068, CNRS UMR 7258, Aix Marseille Université U105, Marseille Cancer Research Center (CRCM), France; Metronomics Global Health Initiative, Marseille, France
| | - Pablo Berlanga
- Gustave Roussy Cancer Campus, Department of Pediatric and Adolescent Oncology, Université Paris-Saclay, Villejuif, France
| | - Susanne A Gatz
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Lynley V Marshall
- Royal Marsden Hospital NHS Foundation Trust Paediatric and Adolescent Oncology Drug Development Unit, and & The Institute of Cancer Research, Division of Clinical Studies, London, United Kingdom
| | - Jonathan Rubino
- Gustave Roussy Cancer Campus, Clinical Research Direction, Université Paris-Saclay, Villejuif, France
| | - Baptiste Archambaud
- Inserm, Université Paris-Saclay, CESP U1018, Oncostat, labeled Ligue Contre le Cancer, Villejuif, France; Gustave Roussy Cancer Campus, Office of Biostatistics and Epidemiology, Université Paris-Saclay, Villejuif, France, Université Paris-Saclay, CESP U1018, Oncostat, labeled Ligue Contre le Cancer, Villejuif, France
| | - Antonin Marchais
- Gustave Roussy Cancer Campus, Department of Pediatric and Adolescent Oncology, Université Paris-Saclay, Villejuif, France; Gustave Roussy Cancer Campus, INSERM U1015, Université Paris-Saclay, Villejuif, France
| | - Alba Rubio-San-Simón
- Hospital Niño Jesús, Department of Pediatric Oncology, Hematology and Stem Cell Transplantation, Madrid, Spain
| | - Stephane Ducassou
- Centre Hospitalier Universitaire Pellegrin - Hôpital des Enfants, Bordeaux, France
| | - C Michel Zwaan
- Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Michela Casanova
- Fondazione IRCCS Istituto Nazionale dei Tumori, Pediatric Oncology Unit, Milan, Italy
| | - Karsten Nysom
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Sophie Pellegrino
- Gustave Roussy Cancer Campus, Clinical Research Direction, Université Paris-Saclay, Villejuif, France
| | | | - Agnes Buzyn
- Institut National de Cancer, Boulogne, France
| | | | - Xavier Paoletti
- Inserm, Université Paris-Saclay, CESP U1018, Oncostat, labeled Ligue Contre le Cancer, Villejuif, France; Gustave Roussy Cancer Campus, Office of Biostatistics and Epidemiology, Université Paris-Saclay, Villejuif, France, Université Paris-Saclay, CESP U1018, Oncostat, labeled Ligue Contre le Cancer, Villejuif, France
| | - Gilles Vassal
- Gustave Roussy Cancer Campus, Department of Pediatric and Adolescent Oncology, Université Paris-Saclay, Villejuif, France; Gustave Roussy Cancer Campus, Clinical Research Direction, Université Paris-Saclay, Villejuif, France
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Bautista F, Verdú-Amorós J, Geoerger B, Rubio-San-Simón A, Paoletti X, Zwaan CM, Casanova M, Marshall LV, Carceller F, Doz F, Lecinse C, Vassal G, Pearson ADJ, Kearns P, Moreno L. Evolution of the Innovative Therapies for Children With Cancer Consortium Trial Portfolio for Drug Development for Children With Cancer. J Clin Oncol 2024; 42:2516-2526. [PMID: 38743911 DOI: 10.1200/jco.23.01237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/09/2024] [Accepted: 02/29/2024] [Indexed: 05/16/2024] Open
Abstract
PURPOSE The aim of the Innovative Therapies for Children with Cancer (ITCC) consortium is to improve access to novel therapies for children and adolescents with cancer. The evolution of the ITCC clinical trial portfolio since 2003 was reviewed. METHODS All ITCC-labeled phase I/II trials opened between January 1, 2003 and February 3, 2018 were analyzed in two periods (2003-2010 and 2011-2018), and data were extracted from the ITCC database, regulatory agencies' registries, and publications. RESULTS Sixty-one trials (62% industry-sponsored) enrolled 3,198 patients. The number of trials in the second period increased by almost 300% (16 v 45). All biomarker-driven trials (n = 14) were conducted in the second period. The use of rolling six and model-based designs increased (1 of 9, 11% v 21 of 31, 68%), and that of 3 + 3 designs decreased (5 of 9, 55% v 5 of 31, 16%; P = .014). The proportion of studies evaluating chemotherapeutics only decreased (5 of 16, 31% v 4 of 45, 9%), the proportion of single-agent targeted therapies did not change (9 of 16, 56.2% v 24 of 45, 53.3%), the proportion of combination targeted therapies trials increased (2 of 16, 12%, v 17 of 45, 38%), the proportion of randomized phase II trials increased (1 of 7, 14% v 8 of 14, 57%). More trials were part of a pediatric investigation plan in the second period (4 of 16, 25% v 21 of 45, 46%). The median time for Ethics Committees' approvals was 1.7 times longer for academic compared with industry-sponsored trials. CONCLUSION This study reports a shift in the paradigm of early drug development for childhood cancers, with more biologically relevant targets evaluated in biomarker-driven trials or in combination with other therapies and with more model-based or randomized designs and a greater focus on fulfilling regulatory requirements. Improvement of trial setup and recruitment could increase the number of patients benefiting from novel agents.
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Affiliation(s)
- Francisco Bautista
- Division of Pediatric Hematology and Oncology, Hospital Universitario Niño Jesús, Madrid, Spain
- Princess Máxima Center, Utrecht, the Netherlands
| | - Jaime Verdú-Amorós
- Division of Pediatric Hematology and Oncology, Hospital Universitario Niño Jesús, Madrid, Spain
- Division of Pediatric Hematology and Oncology, Hospital Clínico Universitario de Valencia, Biomedical Research Institute, INCLIVA, Valencia, Spain
| | - Birgit Geoerger
- Pediatric and Adolescent Oncology Department, Gustave Roussy Cancer Campus, INSERM U1015, Université Paris-Saclay, Villejuif, France
| | - Alba Rubio-San-Simón
- Division of Pediatric Hematology and Oncology, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Xavier Paoletti
- Institut Curie & Université Versailles St Quentin & INSERM U900 STAMPM, Paris, France
| | - C Michel Zwaan
- Princess Máxima Center, Utrecht, the Netherlands
- Department of Pediatric Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lynley V Marshall
- Pediatric and Adolescent Oncology Drug Development, Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Fernando Carceller
- Pediatric and Adolescent Oncology Drug Development, Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Francois Doz
- SIREDO Cancer Center (Care, Innovation and Research in Pediatric, Adolescents, and Young Adults Oncology), Curie Institute Paris, and University Paris Cité, Paris, France
| | - Carole Lecinse
- Innovative Therapies for Children with Cancer, Gustave Roussy Cancer Campus, Villejuif, France
| | - Gilles Vassal
- Innovative Therapies for Children with Cancer, Gustave Roussy Cancer Campus, Villejuif, France
| | - Andrew D J Pearson
- Pediatric and Adolescent Oncology Drug Development, Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Pamela Kearns
- Institute of Cancer and Genomic Sciences, NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom
| | - Lucas Moreno
- Division of Pediatric Hematology and Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Bergamaschi L, Chiaravalli S, Signoroni S, Di Bartolomeo M, Ferrari A. Management and pharmacotherapy of pediatric colorectal carcinoma: a review. Expert Opin Pharmacother 2023; 24:1527-1535. [PMID: 37358925 DOI: 10.1080/14656566.2023.2230123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Colorectal carcinoma (CRC) is one of the most common tumors in adult, but is extremely rare in children. In childhood, CRC often presents unfavorable aggressive histotypes, advanced clinical stage at onset and a worse prognosis. Pediatric CRC series are limited and include few patients, therefore information about treatment strategy and pharmacotherapy is scarce. For this reason, management of these patients represents a real challenge for pediatric oncologists. AREAS COVERED The authors provide an overview of the general features and management strategies of pediatric CRC with specific attention to systemic treatment. Literature data regarding pharmacotherapy in published pediatric series are summarized and analyzed in detail, according to adult treatment standards. EXPERT OPINION In the absence of specific recommendations for pediatric CRC, the general therapeutic strategy should follow the same principles as for adults and should be the result of a multidisciplinary discussion. Patient access to optimal treatment is difficult due to the lack of new drugs approved for the pediatric age group and non-availability of clinical trials. Collaboration between pediatric and adult oncologists is considered crucial in order to overcome these issues and find solutions to increase knowledge and improve the outcome of such a rare disease in children.
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Affiliation(s)
- Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Stefano Signoroni
- Unit of Hereditary Digestive Tract Tumors, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maria Di Bartolomeo
- Gastrointestinal Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
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Valle-Simón P, Borobia AM, Pérez-Martínez A. Clinical research with targeted drugs in paediatric oncology. Drug Discov Today 2023; 28:103672. [PMID: 37330039 DOI: 10.1016/j.drudis.2023.103672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
The development of targeted drugs in paediatric oncology has been notoriously slow, in part due to the peculiarities of this rare and highly heterogeneous population. To provide therapeutic breakthroughs for the highest risk subgroups of childhood cancer, innovative research solutions have been implemented in the last several years by different international collaborative groups and regulators. Here, we discuss and summarise some of these approaches, as well as challenges and unmet needs that are still being addressed. A wide range of topics were covered in this review including molecular diagnosis optimisation, innovative research methodologies, big data approaches, trial enrolment strategies, and improvements in regulation and preclinical research platforms.
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Affiliation(s)
- Paula Valle-Simón
- Clinical Pharmacology Department, La Paz University Hospital, Idipaz, Paseo de la Castellana 261, 28046 Madrid, Spain.
| | - Alberto M Borobia
- Clinical Pharmacology Department, La Paz University Hospital, School of Medicine, Universidad Autónoma de Madrid (UAM) IdiPAZ, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Antonio Pérez-Martínez
- Paediatric Haemato-Oncology Department, La Paz University Hospital, School of Medicine, Universidad Autónoma de Madrid (UAM), IdiPAZ, Paseo de la Castellana 261, 28046 Madrid, Spain
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Shala AL, Arduino I, Salihu MB, Denora N. Quercetin and Its Nano-Formulations for Brain Tumor Therapy—Current Developments and Future Perspectives for Paediatric Studies. Pharmaceutics 2023; 15:pharmaceutics15030963. [PMID: 36986827 PMCID: PMC10057501 DOI: 10.3390/pharmaceutics15030963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
The development of efficient treatments for tumors affecting the central nervous system (CNS) remains an open challenge. Particularly, gliomas are the most malignant and lethal form of brain tumors in adults, causing death in patients just over 6 months after diagnosis without treatment. The current treatment protocol consists of surgery, followed using synthetic drugs and radiation. However, the efficacy of these protocols is associated with side effects, poor prognosis and with a median survival of fewer than two years. Recently, many studies were focused on applying plant-derived products to manage various diseases, including brain cancers. Quercetin is a bioactive compound derived from various fruits and vegetables (asparagus, apples, berries, cherries, onions and red leaf lettuce). Numerous in vivo and in vitro studies highlighted that quercetin through multitargeted molecular mechanisms (apoptosis, necrosis, anti-proliferative activity and suppression of tumor invasion and migration) effectively reduces the progression of tumor cells. This review aims to summarize current developments and recent advances of quercetin’s anticancer potential in brain tumors. Since all reported studies demonstrating the anti-cancer potential of quercetin were conducted using adult models, it is suggested to expand further research in the field of paediatrics. This could offer new perspectives on brain cancer treatment for paediatric patients.
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Affiliation(s)
- Aida Loshaj Shala
- Department of Drug Analysis and Pharmaceutical Technology, Faculty of Medicine, University of Prishtina, 10000 Prishtina, Kosovo
| | - Ilaria Arduino
- Department of Pharmacy—Pharmaceutical Sciences, University of Bari “Aldo Moro”, Orabona St. 4, 70125 Bari, Italy
| | - Mimoza Basholli Salihu
- Department of Drug Analysis and Pharmaceutical Technology, Faculty of Medicine, University of Prishtina, 10000 Prishtina, Kosovo
| | - Nunzio Denora
- Department of Pharmacy—Pharmaceutical Sciences, University of Bari “Aldo Moro”, Orabona St. 4, 70125 Bari, Italy
- Correspondence:
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8
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Aaltonen K, Radke K, Adamska A, Seger A, Mañas A, Bexell D. Patient-derived models: Advanced tools for precision medicine in neuroblastoma. Front Oncol 2023; 12:1085270. [PMID: 36776363 PMCID: PMC9910084 DOI: 10.3389/fonc.2022.1085270] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/21/2022] [Indexed: 01/27/2023] Open
Abstract
Neuroblastoma is a childhood cancer derived from the sympathetic nervous system. High-risk neuroblastoma patients have a poor overall survival and account for ~15% of childhood cancer deaths. There is thus a need for clinically relevant and authentic models of neuroblastoma that closely resemble the human disease to further interrogate underlying mechanisms and to develop novel therapeutic strategies. Here we review recent developments in patient-derived neuroblastoma xenograft models and in vitro cultures. These models can be used to decipher mechanisms of metastasis and treatment resistance, for drug screening, and preclinical drug testing. Patient-derived neuroblastoma models may also provide useful information about clonal evolution, phenotypic plasticity, and cell states in relation to neuroblastoma progression. We summarize current opportunities for, but also barriers to, future model development and application. Integration of patient-derived models with patient data holds promise for the development of precision medicine treatment strategies for children with high-risk neuroblastoma.
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Target actionability review to evaluate CDK4/6 as a therapeutic target in paediatric solid and brain tumours. Eur J Cancer 2022; 170:196-208. [PMID: 35671543 DOI: 10.1016/j.ejca.2022.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 04/01/2022] [Accepted: 04/13/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Childhood cancer is still a leading cause of death around the world. To improve outcomes, there is an urgent need for tailored treatment. The systematic evaluation of existing preclinical data can provide an overview of what is known and identify gaps in the current knowledge. Here, we applied the target actionability review (TAR) methodology to assess the strength and weaknesses of available scientific literature on CDK4/6 as a therapeutic target in paediatric solid and brain tumours by structured critical appraisal. METHODS Using relevant search terms in PubMed, a list of original publications investigating CDK4/6 in paediatric solid tumour types was identified based on relevancy criteria. Each publication was annotated for the tumour type and categorised into separate proof-of-concept (PoC) data modules. Based on rubrics, quality and experimental outcomes were scored independently by two reviewers. A third reviewer evaluated and adjudicated score discrepancies. Scores for each PoC module were averaged for each tumour type and visualised in a heatmap matrix in the publicly available R2 data portal. RESULTS AND CONCLUSIONS This CDK4/6 TAR, generated by analysis of 151 data entries from 71 publications, showed frequent genomic aberrations of CDK4/6 in rhabdomyosarcoma, osteosarcoma, high-grade glioma, medulloblastoma, and neuroblastoma. However, a clear correlation between CDK4/6 aberrations and compound efficacy is not coming forth from the literature. Our analysis indicates that several paediatric indications would need (further) preclinical evaluation to allow for better recommendations, especially regarding the dependence of tumours on CDK4/6, predictive biomarkers, resistance mechanisms, and combination strategies. Nevertheless, our TAR heatmap provides support for the relevance of CDK4/6 inhibition in Ewing sarcoma, medulloblastoma, malignant peripheral nerve sheath tumour and to a lesser extent neuroblastoma, rhabdomyosarcoma, rhabdoid tumour and high-grade glioma. The interactive heatmap is accessible through R2 [r2platform.com/TAR/CDK4_6].
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10
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ACCELERATE – Five years accelerating cancer drug development for children and adolescents. Eur J Cancer 2022; 166:145-164. [DOI: 10.1016/j.ejca.2022.01.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/06/2022] [Accepted: 01/17/2022] [Indexed: 02/06/2023]
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11
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Keller KM, Krausert S, Gopisetty A, Luedtke D, Koster J, Schubert NA, Rodríguez A, van Hooff SR, Stichel D, Dolman MEM, Vassal G, Pfister SM, Caron HN, Stancato LF, Molenaar JJ, Jäger N, Kool M. Target Actionability Review: a systematic evaluation of replication stress as a therapeutic target for paediatric solid malignancies. Eur J Cancer 2021; 162:107-117. [PMID: 34963094 DOI: 10.1016/j.ejca.2021.11.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/29/2021] [Accepted: 11/30/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Owing to the high numbers of paediatric cancer-related deaths, advances in therapeutic options for childhood cancer is a heavily studied field, especially over the past decade. Classical chemotherapy offers some therapeutic benefit but has proven long-term complications in survivors, and there is an urgent need to identify novel target-driven therapies. Replication stress is a major cause of genomic instability in cancer, triggering the stalling of the replication fork. Failure of molecular response by DNA damage checkpoints, DNA repair mechanisms and restarting the replication forks can exacerbate replication stress and initiate cell death pathways, thus presenting as a novel therapeutic target. To bridge the gap between preclinical evidence and clinical utility thereof, we apply the literature-driven systematic target actionability review methodology to published proof-of-concept (PoC) data related to the process of replication stress. METHODS A meticulous PubMed literature search was performed to gather replication stress-related articles (published between 2014 and 2021) across 16 different paediatric solid tumour types. Articles that fulfilled inclusion criteria were uploaded into the R2 informatics platform [r2.amc.nl] and assessed by critical appraisal. Key evidence based on nine pre-established PoC modules was summarised, and scores based on the quality and outcome of each study were assigned by two separate reviewers. Articles with discordant modules/scores were re-scored by a third independent reviewer, and a final consensus score was agreed upon by adjudication between all three reviewers. To visualise the final scores, an interactive heatmap summarising the evidence and scores associated with each PoC module across all, including paediatric tumour types, were generated. RESULTS AND CONCLUSIONS 145 publications related to targeting replication stress in paediatric tumours were systematically reviewed with an emphasis on DNA repair pathways and cell cycle checkpoint control. Although various targets in these pathways have been studied in these diseases to different extents, the results of this extensive literature search show that ATR, CHK1, PARP or WEE1 are the most promising targets using either single agents or in combination with chemotherapy or radiotherapy in neuroblastoma, osteosarcoma, high-grade glioma or medulloblastoma. Targeting these pathways in other paediatric malignancies may work as well, but here, the evidence was more limited. The evidence for other targets (such as ATM and DNA-PK) was also limited but showed promising results in some malignancies and requires more studies in other tumour types. Overall, we have created an extensive overview of targeting replication stress across 16 paediatric tumour types, which can be explored using the interactive heatmap on the R2 target actionability review platform [https://hgserver1.amc.nl/cgi-bin/r2/main.cgi?option=imi2_targetmap_v1].
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Affiliation(s)
- Kaylee M Keller
- Princess Máxima Center for Paediatric Oncology, Utrecht, the Netherlands
| | - Sonja Krausert
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany; Division of Paediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Apurva Gopisetty
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany; Division of Paediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Dan Luedtke
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Jan Koster
- Department of Oncogenomics, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Nil A Schubert
- Princess Máxima Center for Paediatric Oncology, Utrecht, the Netherlands
| | | | - Sander R van Hooff
- Princess Máxima Center for Paediatric Oncology, Utrecht, the Netherlands
| | - Damian Stichel
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Emmy M Dolman
- Princess Máxima Center for Paediatric Oncology, Utrecht, the Netherlands; Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, NSW, Australia; School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, NSW Australia
| | - Gilles Vassal
- Department of Clinical Research, Gustave Roussy, Villejuif, France
| | - Stefan M Pfister
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany; Division of Paediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany; Department of Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | | | | | - Jan J Molenaar
- Princess Máxima Center for Paediatric Oncology, Utrecht, the Netherlands
| | - Natalie Jäger
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany; Division of Paediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Marcel Kool
- Princess Máxima Center for Paediatric Oncology, Utrecht, the Netherlands; Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany; Division of Paediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany.
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12
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Blattner-Johnson M, Jones DTW, Pfaff E. Precision medicine in pediatric solid cancers. Semin Cancer Biol 2021; 84:214-227. [PMID: 34116162 DOI: 10.1016/j.semcancer.2021.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 12/18/2022]
Abstract
Despite huge advances in the diagnosis and treatment of pediatric cancers over the past several decades, it remains one of the leading causes of death during childhood in developed countries. The development of new targeted treatments for these diseases has been hampered by two major factors. First, the extremely heterogeneous nature of the types of tumors encountered in this age group, and their fundamental differences from common adult carcinomas, has made it hard to truly get a handle on the complexities of the underlying biology driving tumor growth. Second, a reluctance of the pharmaceutical industry to develop products or trials for this population due to the relatively small size of the 'market', and a too-easy mechanism of obtaining waivers for pediatric development of adult oncology drugs based on disease type rather than mechanism of action, led to significant difficulties in getting access to new drugs. Thankfully, the field has now started to change, both scientifically and from a regulatory perspective, in order to address some of these challenges. In this review, we will examine some of the recent insights into molecular features which make pediatric tumors so unique and how these might represent therapeutic targets; highlight ongoing international initiatives for providing comprehensive, personalized genomic profiling of childhood tumors in a clinically-relevant timeframe, and look briefly at where the field of pediatric precision oncology may be heading in future.
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Affiliation(s)
- Mirjam Blattner-Johnson
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany; Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David T W Jones
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany; Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Elke Pfaff
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany; Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
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13
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Rubio-San-Simón A, Hladun Alvaro R, Juan Ribelles A, Castañeda Heredia A, Guerra-García P, Verdú-Amorós J, Andrés M, Cañete A, Rives S, Pérez-Martínez A, Mora J, Patiño-García A, Lassaleta A, Llort A, Ramírez M, Mata C, Gallego S, Martín-Broto J, Cruz O, Morales La Madrid A, Solano P, Martínez Romera I, Fernández-Teijeiro A, Bautista F, Moreno L. The paediatric cancer clinical research landscape in Spain: a 13-year multicentre experience of the new agents group of the Spanish Society of Paediatric Haematology and Oncology (SEHOP). Clin Transl Oncol 2021; 23:2489-2496. [PMID: 34076861 DOI: 10.1007/s12094-021-02649-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Early phase trials are crucial in developing innovative effective agents for childhood malignancies. We report the activity in early phase paediatric oncology trials in Spain from its beginning to the present time and incorporate longitudinal data to evaluate the trends in trial characteristics and recruitment rates. METHODS Members of SEHOP were contacted to obtain information about the open trials at their institutions. The study period was split into two equal periods for analysis: 2007-2013 and 2014-2020. RESULTS Eighty-one trials and two molecular platforms have been initiated. The number of trials has increased over the time of the study for all tumour types, with a predominance of trials available for solid tumours (66%). The number of trials addressed to tumours harbouring specific molecular alterations has doubled during the second period. The proportion of industry-sponsored compared to academic trials has increased over the same years. A total of 565 children and adolescents were included, with an increasing trend over the study period. For international trials, the median time between the first country study approval and the Spanish competent authority approval was 2 months (IQR 0-6.5). Fourteen out of 81 trials were sponsored by Spanish academic institutions. CONCLUSIONS The number of available trials, and the number of participating patients, has increased in Spain from 2007. Studies focused on molecular-specific targets are now being implemented. Barriers to accessing new drugs for all ranges of age and cancer diseases remain. Additionally, opportunities to improve academic research are still required in Spain.
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Affiliation(s)
- A Rubio-San-Simón
- Paediatric Oncology-Haematology Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - R Hladun Alvaro
- Paediatric Oncology-Haematology Department, Hospital Universitario Vall D'Hebrón, Barcelona, Spain
| | - A Juan Ribelles
- Paediatric Oncology-Haematology Department, Hospital Universitario Y Politécnico de La Fe, Valencia, Spain
| | | | - P Guerra-García
- Paediatric Oncology-Haematology Department, Hospital La Paz Institute for Health Research-IdiPAZ, Madrid, Spain
| | - J Verdú-Amorós
- Paediatric Oncology-Haematology Department, Hospital Clínico Universitario, Valencia, Spain
| | - M Andrés
- Paediatric Oncology-Haematology Department, Hospital Universitario Y Politécnico de La Fe, Valencia, Spain
| | - A Cañete
- Paediatric Oncology-Haematology Department, Hospital Universitario Y Politécnico de La Fe, Valencia, Spain
| | - S Rives
- Paediatric Oncology-Haematology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - A Pérez-Martínez
- Paediatric Oncology-Haematology Department, Hospital La Paz, Madrid, Spain
| | - J Mora
- Paediatric Oncology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - A Patiño-García
- Paediatric Oncology-Haematology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - A Lassaleta
- Paediatric Oncology-Haematology Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - A Llort
- Paediatric Oncology-Haematology Department, Hospital Universitario Vall D'Hebrón, Barcelona, Spain
| | - M Ramírez
- Paediatric Oncology-Haematology Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - C Mata
- Paediatric Oncology-Haematology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - S Gallego
- Paediatric Oncology-Haematology Department, Hospital Universitario Vall D'Hebrón, Barcelona, Spain
| | - J Martín-Broto
- Medical Oncology Department, Fundación Jiménez Díaz, Madrid, Spain
| | - O Cruz
- Paediatric Oncology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - P Solano
- Paediatric Oncology-Haematology Department, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - I Martínez Romera
- Paediatric Oncology-Haematology Department, Hospital La Paz, Madrid, Spain
| | - A Fernández-Teijeiro
- Paediatric Oncology-Haematology Unit, Hospital Universitario Virgen Macarena, Seville, Spain
| | - F Bautista
- Paediatric Oncology-Haematology Department, Hospital Universitario Niño Jesús, Madrid, Spain. .,Paediatric Oncology, Haematology and Haematopoietic Stem Cell Transplant Department, Hospital Universitario Niño Jesús, Avenida Menéndez Pelayo, 65, 28009, Madrid, Spain.
| | - L Moreno
- Paediatric Oncology-Haematology Department, Hospital Universitario Vall D'Hebrón, Barcelona, Spain
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Rubio-San-Simón A, André N, Cefalo MG, Aerts I, Castañeda A, Benezech S, Makin G, van Eijkelenburg N, Nysom K, Marshall L, Gambart M, Hladun R, Rossig C, Bergamaschi L, Fagioli F, Carpenter B, Ducassou S, Owens C, Øra I, Ribelles AJ, De Wilde B, Guerra-García P, Strullu M, Rizzari C, Ek T, Hettmer S, Gerber NU, Rawlings C, Diezi M, Palmu S, Ruggiero A, Verdú J, de Rojas T, Vassal G, Geoerger B, Moreno L, Bautista F. Impact of COVID-19 in paediatric early-phase cancer clinical trials in Europe: A report from the Innovative Therapies for Children with Cancer (ITCC) consortium. Eur J Cancer 2020; 141:82-91. [PMID: 33129040 PMCID: PMC7546235 DOI: 10.1016/j.ejca.2020.09.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/25/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Data regarding real-world impact on cancer clinical research during COVID-19 are scarce. We analysed the impact of the COVID-19 pandemic on the conduct of paediatric cancer phase I-II trials in Europe through the experience of the Innovative Therapies for Children with Cancer (ITCC). METHODS A survey was sent to all ITCC-accredited early-phase clinical trial hospitals including questions about impact on staff activities, recruitment, patient care, supply of investigational products and legal aspects, between 1st March and 30th April 2020. RESULTS Thirty-one of 53 hospitals from 12 countries participated. Challenges reported included staff constraints (30% drop), reduction in planned monitoring activity (67% drop of site initiation visits and 64% of monitoring visits) and patient recruitment (61% drop compared with that in 2019). The percentage of phase I, phase II trials and molecular platforms closing to recruitment in at least one site was 48.5%, 61.3% and 64.3%, respectively. In addition, 26% of sites had restrictions on performing trial assessments because of local contingency plans. Almost half of the units suffered impact upon pending contracts. Most hospitals (65%) are planning on improving organisational and structural changes. CONCLUSION The study reveals a profound disruption of paediatric cancer early-phase clinical research due to the COVID-19 pandemic across Europe. Reported difficulties affected both patient care and monitoring activity. Efforts should be made to reallocate resources to avoid lost opportunities for patients and to allow the continued advancement of oncology research. Identified adaptations to clinical trial procedures may be integrated to increase preparedness of clinical research to futures crises.
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Affiliation(s)
- Alba Rubio-San-Simón
- Paediatric Haematology-Oncology Department, Children's University Hospital Niño Jesús, Madrid, Spain
| | - Nicolas André
- Paediatric Haematology-Oncology Department, Hôpital pour enfant de La Timone, AP-HM, Marseille, France
| | - Maria Giuseppina Cefalo
- Onco-Hematology, Cell and Gene Therapy Department, Bambino Gesù Childrens Hospital, Rome, Italy
| | - Isabelle Aerts
- Paediatric Haematology-Oncology Department, Institut Curie, Paris, France
| | - Alicia Castañeda
- Paediatric Haematology-Oncology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Sarah Benezech
- Paediatric Haematology-Oncology Department, Institut d’Hematologie et Oncologie Pédiatrique IHOPe, Lyon, France
| | - Guy Makin
- Paediatric Haematology-Oncology Department, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | | | - Karsten Nysom
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Lynley Marshall
- Paediatric Haematology-Oncology Department, Oak Centre for Children & Young People, The Royal Marsden Hospital & the Institute of Cancer Research, London, United Kingdom
| | - Marion Gambart
- Paediatric Haematology-Oncology Department, Hôpital des enfants CHU, Toulouse, France
| | - Raquel Hladun
- Division of Paediatric Haematology and Oncology, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Claudia Rossig
- Paediatric Haematology-Oncology Department, University Children´s Hospital, Muenster, Germany
| | - Luca Bergamaschi
- Paediatric Haematology-Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Franca Fagioli
- Paediatric Haematology-Oncology Department, Regina Margherita Children's Hospital, A.O.U. Citta della Salute di Torino, Torino, Italy
| | - Ben Carpenter
- Paediatric Haematology-Oncology Department, University College London Hospitals, London, United Kingdom
| | - Stephane Ducassou
- Paediatric Haematology-Oncology Department, Centre Hospitalier Universitaire (CHU), Bordeaux, France
| | - Cormac Owens
- Paediatric Haematology-Oncology Department, Children's Health Ireland, Crumlin, Dublin, Ireland
| | - Ingrid Øra
- Department of Paediatric Haematology-Oncology, University Hospital, Stockholm, Sweden
| | - Antonio Juan Ribelles
- Paediatric Haematology-Oncology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Bram De Wilde
- Paediatric Haematology-Oncology Department, Ghent University Hospital, Ghent, Belgium
| | - Pilar Guerra-García
- Paediatric Haematology-Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Marion Strullu
- Paediatric Haematology-Oncology Department, Hôpital Robert-Debré Ap-Hp, Paris, France
| | - Carmelo Rizzari
- Paediatric Haematology-Oncology Department, Clinica Pediatrica Fondazione MBBM, Monza, Italy
| | - Torben Ek
- Paediatric Haematology-Oncology Department, Childhood Cancer Centre, Gothenburg, Sweden
| | - Simone Hettmer
- Division of Paediatric Haematology-Oncology Department, Department of Paediatric and Adolescent Medicine, Faculty of Medicine, University of Freiburg, Germany
| | - Nicolas U. Gerber
- Department of Paediatric Oncology, University Children's Hospital, Zurich, Switzerland
| | - Christine Rawlings
- Paediatric Haematology-Oncology Department, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - Manuel Diezi
- Pediatric Hematology-Oncology Unit, Division of Paediatrics, Department “Woman-Mother-Child”, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Sauli Palmu
- Center for Child Health Research, Tampere University and Department of Pediatrics, Tampere University Hospital, Tampere, Finland, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antonio Ruggiero
- Paediatric Haematology-Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS -Universita’ Cattolica Sacro Cuore, Rome Italy
| | - Jaime Verdú
- Paediatric Haematology-Oncology Department, Children's University Hospital Niño Jesús, Madrid, Spain
| | - Teresa de Rojas
- Paediatric Haematology-Oncology Department, Children's University Hospital Niño Jesús, Madrid, Spain
| | - Gilles Vassal
- Paediatric and Adolescent Oncology Department Gustave Roussy Cancer Campus, INSERM U1015, Université Paris-Saclay, Villejuif, France
| | - Birgit Geoerger
- Paediatric and Adolescent Oncology Department Gustave Roussy Cancer Campus, INSERM U1015, Université Paris-Saclay, Villejuif, France
| | - Lucas Moreno
- Division of Paediatric Haematology and Oncology, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Francisco Bautista
- Paediatric Haematology-Oncology Department, Children's University Hospital Niño Jesús, Madrid, Spain,Corresponding author: Paediatric Oncology, Haematology and Haematopoietic Stem Cell Transplant Department, Hospital Universitario Niño Jesús, Avenida Menéndez Pelayo, 65, 28009, Madrid, Spain
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15
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Schubert NA, Schild L, van Oirschot S, Keller KM, Alles LK, Vernooij L, Nulle ME, Dolman MEM, van den Boogaard ML, Molenaar JJ. Combined targeting of the p53 and pRb pathway in neuroblastoma does not lead to synergistic responses. Eur J Cancer 2020; 142:1-9. [PMID: 33190064 DOI: 10.1016/j.ejca.2020.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/01/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Despite intensive treatment protocols and recent advances, neuroblastomas still account for approximately 15% of all childhood cancer deaths. In contrast with adult cancers, p53 pathway inactivation in neuroblastomas is rarely caused by p53 mutation but rather by altered MDM2 or p14ARF expression. Moreover, neuroblastomas are characterised by high proliferation rates, frequently triggered by pRb pathway dysfunction due to aberrant expression of cyclin D1, CDK4 or p16INK4a. Simultaneous disturbance of these pathways can occur via co-amplification of MDM2 and CDK4 or homozygous deletion of CDKN2A, which encodes both p14ARF and p16INK4a. METHODS AND RESULTS We examined whether both single and combined inhibition of MDM2 and CDK4/6 is effective in reducing neuroblastoma cell viability. In our panel of ten cell lines with a spectrum of aberrations in the p53 and pRb pathway, idasanutlin and abemaciclib were the most potent MDM2 and CDK4/6 inhibitors, respectively. No correlation was observed between the genetic background and response to the single inhibitors. We confirmed this lack of correlation in isogenic systems overexpressing MDM2 and/or CDK4. In addition, combined inhibition did not result in synergistic effects. Instead, abemaciclib diminished the pro-apoptotic effect of idasanutlin, leading to slightly antagonistic effects. In vivo treatment with idasanutlin and abemaciclib led to reduced tumour growth compared with single drug treatment, but no synergistic response was observed. CONCLUSION We conclude that p53 and pRb pathway aberrations cannot be used as predictive biomarkers for neuroblastoma sensitivity to MDM2 and/or CDK4/6 inhibitors. Moreover, we advise to be cautious with combining these inhibitors in neuroblastomas.
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Affiliation(s)
- Nil A Schubert
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Linda Schild
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Kaylee M Keller
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Lindy K Alles
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Lindy Vernooij
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Marloes E Nulle
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - M Emmy M Dolman
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Jan J Molenaar
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
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Rubio-San-Simón A, Verdú-Amorós J, Hladun R, Juan-Ribelles A, Molero M, Guerra-García P, Pérez-Martínez A, Castañeda A, Cañete A, de Rojas T, Moreno L, Bautista F. Challenges in early phase clinical trials for childhood cancer during the COVID-19 pandemic: a report from the new agents group of the Spanish Society of Paediatric Haematology and Oncology (SEHOP). Clin Transl Oncol 2020; 23:183-189. [PMID: 32472454 PMCID: PMC7258607 DOI: 10.1007/s12094-020-02399-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE The COVID-19 pandemic has forced healthcare stakeholders towards challenging decisions. We analyse the impact of the pandemic on the conduct of phase I-II trials for paediatric cancer during the first month of state of alarm in Spain. METHODS A questionnaire was sent to all five ITCC-accredited Spanish Paediatric Oncology Early Phase Clinical Trial Units, including questions about impact on staff activities, recruitment, patient care, supply of investigational products, and legal aspects. RESULTS All units suffered personnel shortages and difficulties in enrolling patients, treatment continuity, or performing trial assessments. Monitoring activity was frequently postponed (73%), and 49% of on-going trials interrupted recruitment. Only two patients could be recruited during this period (75% reduction in the expected rate). CONCLUSIONS The COVID-19 crisis has significantly impacted clinical research practice and access to innovation for children with cancer. Structural and functional changes are under way to better cope with the expected future restrictions.
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Affiliation(s)
- A Rubio-San-Simón
- Division of Paediatric Haematology and Oncology, Hospital Universitario Niño Jesús, Madrid, Spain
| | - J Verdú-Amorós
- Division of Paediatric Haematology and Oncology, Hospital Universitario Niño Jesús, Madrid, Spain
| | - R Hladun
- Division of Paediatric Haematology and Oncology, Hospital Universitari Vall D´Hebron, Barcelona, Spain
| | - A Juan-Ribelles
- Division of Paediatric Haematology and Oncology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M Molero
- Division of Paediatric Haematology and Oncology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - P Guerra-García
- Division of Paediatric Haematology and Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - A Pérez-Martínez
- Division of Paediatric Haematology and Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - A Castañeda
- Division of Paediatric Haematology and Oncology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - A Cañete
- Division of Paediatric Haematology and Oncology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - T de Rojas
- Division of Paediatric Haematology and Oncology, Hospital Universitario Niño Jesús, Madrid, Spain
| | - L Moreno
- Division of Paediatric Haematology and Oncology, Hospital Universitari Vall D´Hebron, Barcelona, Spain
| | - F Bautista
- Division of Paediatric Haematology and Oncology, Hospital Universitario Niño Jesús, Madrid, Spain.
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17
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Schubert NA, Lowery CD, Bergthold G, Koster J, Eleveld TF, Rodríguez A, Jones DTW, Vassal G, Stancato LF, Pfister SM, Caron HN, Molenaar JJ. Systematic target actionability reviews of preclinical proof-of-concept papers to match targeted drugs to paediatric cancers. Eur J Cancer 2020; 130:168-181. [PMID: 32224415 PMCID: PMC7203547 DOI: 10.1016/j.ejca.2020.01.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 01/17/2023]
Abstract
Background Children with cancer are in urgent need of new therapies, as approximately 25% of patients experience a relapse and 20% succumb to their disease. Moreover, the majority of survivors suffer from clinically relevant health problems. Repurposing of targeted agents developed for adult indications could provide novel therapeutic options for paediatric cancer patients. To prioritise targeted drugs for paediatric clinical development, we applied a systematic review methodology to develop a Target Actionability Review (TAR) strategy. These TARs assess the strength and completeness of published preclinical proof-of-concept (PoC) data by structured critical appraisal of and summarising the available scientific literature for a specific target (pathway) and the associated drugs in paediatric tumours. Methods A sensitive literature search in PubMed was performed and relevant papers were identified. For each paper, the individual experimental findings were extracted, marked for paediatric tumour type and categorised into nine separate PoC data modules. Each experimental finding was scored for experimental outcome and quality independently by two reviewers; discrepancies were assessed by a third reviewer and resolved by adjudication. Scores corresponding to one PoC module were merged for each tumour type and visualised in a heat map matrix in the publicly available R2 data portal [r2.amc.nl]. Results and conclusions To test our TAR methodology, we conducted a pilot study on MDM2 and TP53. The heat map generated from analysis of 161 publications provides a rationale to support drug development in specific paediatric solid and brain tumour types. Furthermore, our review highlights tumour types where preclinical data are incomplete or lacking and for which additional preclinical testing is advisable. A new strategy to review literature on targeted compounds in paediatric cancer. Results help to guide and prioritise clinical development of novel targeted agents. Outcomes are visualised in a publicly available, interactive heat map. We applied this unique methodology to MDM2 and TP53 and MDM2 inhibitors.
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Affiliation(s)
- Nil A Schubert
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | | | - Jan Koster
- Department of Oncogenomics, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Thomas F Eleveld
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - David T W Jones
- Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gilles Vassal
- Department of Clinical Research, Gustave Roussy, Villejuif, France
| | | | - Stefan M Pfister
- Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg University Hospital, Heidelberg, Germany
| | | | - Jan J Molenaar
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
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18
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Cairo MS, Beishuizen A. Childhood, adolescent and young adult non-Hodgkin lymphoma: current perspectives. Br J Haematol 2019; 185:1021-1042. [PMID: 30729513 PMCID: PMC6897376 DOI: 10.1111/bjh.15764] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The 6th International Symposium on Childhood, Adolescent and Young Adult (CAYA) Non-Hodgkin Lymphoma (NHL) was held in Rotterdam, Netherlands, 26-29 September, 2018. This summary manuscript is a perspective on the presentations from the plenary scientific sessions, including wellness and survivorship, B-cell NHL, AYA lymphoma, translational NHL biology, lymphoma immunology, bone marrow transplantation and cell therapy, T/Natural Killer cell lymphoma, anaplastic large cell lymphoma, lymphoblastic lymphoma, novel lymphoma therapeutics and Hodgkin lymphoma. The symposium was attended by over 260 registrants from 42 different countries and included young, middle and senior investigators. Finally, the Angelo Rosolen, MD, Memorial Lecture was delivered by Alfred Reiter, MD.
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Affiliation(s)
- Mitchell S. Cairo
- Departments of Pediatrics, Medicine, Pathology, Microbiology& Immunology, and Cell Biology & Anatomy, New York Medical College, Valhalla, NY, USA
| | - Auke Beishuizen
- Division of Paediatric Haemato-Oncology, Princess Maxima Centre for Paediatric Oncology, Utrecht
- Department of Paediatric Oncology/Haematology, Erasmus MC - Sophia Children’s Hospital, Rotterdam, The Netherlands
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19
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Paatero I, Veikkolainen V, Mäenpää M, Schmelzer E, Belting HG, Pelliniemi LJ, Elenius K. ErbB4 tyrosine kinase inhibition impairs neuromuscular development in zebrafish embryos. Mol Biol Cell 2018; 30:209-218. [PMID: 30462579 PMCID: PMC6589560 DOI: 10.1091/mbc.e18-07-0460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Tyrosine kinase inhibitors are widely used in the clinic, but limited information is available about their toxicity in developing organisms. Here, we tested the effect of tyrosine kinase inhibitors targeting the ErbB receptors for their effects on developing zebrafish (Danio rerio) embryos. Embryos treated with wide-spectrum pan-ErbB inhibitors or erbb4a-targeting antisense oligonucleotides demonstrated reduced locomotion, reduced diameter of skeletal muscle fibers, and reduced expression of muscle-specific genes, as well as reduced motoneuron length. The phenotypes in the skeletal muscle, as well as the defect in motility, were rescued both by microinjection of human ERBB4 mRNA and by transposon-mediated muscle-specific ERBB4 overexpression. The role of ErbB4 in regulating motility was further controlled by targeted mutation of the endogenous erbb4a locus in the zebrafish genome by CRISPR/Cas9. These observations demonstrate a potential for the ErbB tyrosine kinase inhibitors to induce neuromuscular toxicity in a developing organism via a mechanism involving inhibition of ErbB4 function.
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Affiliation(s)
- Ilkka Paatero
- Institute of Biomedicine, University of Turku, FIN-20520 Turku, Finland.,Medicity Research Laboratory, University of Turku, FIN-20520 Turku, Finland.,Laboratory of Animal Physiology, Department of Biology, University of Turku, FIN-20520 Turku, Finland.,Biozentrum der Universität Basel, CH-4056 Basel, Switzerland.,Turku Centre for Biotechnology, University of Turku and Åbo Akademi University, FIN-20520 Turku, Finland
| | - Ville Veikkolainen
- Institute of Biomedicine, University of Turku, FIN-20520 Turku, Finland.,Medicity Research Laboratory, University of Turku, FIN-20520 Turku, Finland
| | - Matias Mäenpää
- Institute of Biomedicine, University of Turku, FIN-20520 Turku, Finland
| | | | | | | | - Klaus Elenius
- Institute of Biomedicine, University of Turku, FIN-20520 Turku, Finland.,Medicity Research Laboratory, University of Turku, FIN-20520 Turku, Finland.,Department of Oncology, University of Turku, FIN-20520 Turku, Finland
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20
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Bautista F, Moreno L, Marshall L, Pearson ADJ, Geoerger B, Paoletti X. Revisiting the definition of dose-limiting toxicities in paediatric oncology phase I clinical trials: An analysis from the Innovative Therapies for Children with Cancer Consortium. Eur J Cancer 2017; 86:275-284. [PMID: 29055843 DOI: 10.1016/j.ejca.2017.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/13/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Dose-escalation trials aim to identify the maximum tolerated dose and, importantly, the recommended phase II dose (RP2D) and rely on the occurrence of dose-limiting toxicities (DLTs) during the first treatment cycle. Molecularly targeted agents (MTAs) often follow continuous and prolonged administrations, displaying a distinct toxicity profile compared to conventional chemotherapeutics, and classical DLT criteria might not be appropriate to evaluate MTAs' toxicity. We investigated this issue in children. METHODS The Innovative Therapies for Children with Cancer Consortium (ITCC) phase I trials of novel anticancer agents between 2004 and 2015 were analysed. Data from investigational product, trial design, items defining DLT/RP2D were extracted. A survey on dose-escalation process, DLTs and RP2D definition was conducted among the ITCC clinical trials committee members. RESULTS Thirteen phase I trials with 15 dose-escalation cohorts were analysed. They explored 11 MTAs and 2 novel cytotoxics; 12 evaluated DLT during cycle 1. Definition of DLT was heterogeneous: Grade III-IV haematologic toxicities that were transient or asymptomatic and grade III-IV non-haematological toxicities manageable with adequate supportive care were often excluded, whereas some included dose intensity or grade II toxicities into DLT. None of the studies considered delayed toxicity into the RP2D definition. CONCLUSION DLTs should be homogeneously defined across trials, limiting the number of exceptions due to specific toxicities. Dose escalation should still be based on safety data from cycle 1, but delayed and overall toxicities, pharmacokinetic parameters and pharmacodynamic data should be considered to refine the final RP2D. The evaluation of long-term toxicity in the developing child cannot be adequately addressed in early trials.
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Affiliation(s)
- Francisco Bautista
- Clinical Research Unit, Pediatric Oncology, Hematology and Stem Cell Transplant Department, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo, 65, 28009, Madrid, Spain.
| | - Lucas Moreno
- Clinical Research Unit, Pediatric Oncology, Hematology and Stem Cell Transplant Department, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo, 65, 28009, Madrid, Spain.
| | - Lynley Marshall
- Pediatric Drug Development Team, The Royal Marsden Hospital, Division of Cancer Therapeutics and Clinical Studies, The Institute of Cancer Research, Sutton SM2 5NG, UK.
| | - Andrew D J Pearson
- Pediatric Drug Development Team, The Royal Marsden Hospital, Division of Cancer Therapeutics and Clinical Studies, The Institute of Cancer Research, Sutton SM2 5NG, UK.
| | - Birgit Geoerger
- Gustave Roussy, Pediatric and Adolescent Oncology, Villejuif, France; CNRS UMR8203, Univ. Paris-Sud, Université Paris-Saclay, Villejuif, France.
| | - Xavier Paoletti
- Gustave Roussy, Biostatistics and Epidemiology Unit, Villejuif, France; INSERM U1018, CESP, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France.
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21
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Bautista F, Gallego S, Cañete A, Mora J, Díaz de Heredia C, Cruz O, Fernández JM, Rives S, Berlanga P, Hladun R, Juan Ribelles A, Madero L, Ramírez M, Fernández Delgado R, Pérez-Martínez A, Mata C, Llort A, Martín Broto J, Cela ME, Ramírez G, Sábado C, Acha T, Astigarraga I, Sastre A, Muñoz A, Guibelalde M, Moreno L. Early clinical trials in paediatric oncology in Spain: A nationwide perspective. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2016.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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22
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Moreno L, Pearson ADJ, Paoletti X, Jimenez I, Geoerger B, Kearns PR, Zwaan CM, Doz F, Baruchel A, Vormoor J, Casanova M, Pfister SM, Morland B, Vassal G. Early phase clinical trials of anticancer agents in children and adolescents - an ITCC perspective. Nat Rev Clin Oncol 2017; 14:497-507. [PMID: 28508875 DOI: 10.1038/nrclinonc.2017.59] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In the past decade, the landscape of drug development in oncology has evolved dramatically; however, this paradigm shift remains to be adopted in early phase clinical trial designs for studies of molecularly targeted agents and immunotherapeutic agents in paediatric malignancies. In drug development, prioritization of drugs on the basis of knowledge of tumour biology, molecular 'drivers' of disease and a drug's mechanism of action, and therapeutic unmet needs are key elements; these aspects are relevant to early phase paediatric trials, in which molecular profiling is strongly encouraged. Herein, we describe the strategy of the Innovative Therapies for Children with Cancer (ITCC) Consortium, which advocates for the adoption of trial designs that enable uninterrupted patient recruitment, the extrapolation from studies in adults when possible, and the inclusion of expansion cohorts. If a drug has neither serious dose-related toxicities nor a narrow therapeutic index, then studies should generally be started at the adult recommended phase II dose corrected for body surface area, and act as dose-confirmation studies. The use of adaptive trial designs will enable drugs with promising activity to progress rapidly to randomized studies and, therefore, will substantially accelerate drug development for children and adolescents with cancer.
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Affiliation(s)
- Lucas Moreno
- Paediatric Phase I-II Clinical Trials Unit, Paediatric Haematology &Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Andrew D J Pearson
- Paediatric Drug Development, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK; and at the Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK
| | - Xavier Paoletti
- Biostatistics and Epidemiology, INSERM U1018, Gustave Roussy, Paris, France
| | - Irene Jimenez
- Department of Paediatric, Adolescents and Young Adults Oncology, Institut Curie; and at the University Paris Descartes, Paris, France
| | - Birgit Geoerger
- Department of Paediatric and Adolescent Oncology, CNRS UMR 8203 Vectorology and Anticancer Treatments, Gustave Roussy, University Paris-Sud, Villejuif, France
| | - Pamela R Kearns
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - C Michel Zwaan
- Department of Paediatric Oncology/Haematology, Erasmus MC/Sophia Children's Hospital, Rotterdam, Netherlands
| | - Francois Doz
- Department of Paediatric, Adolescents and Young Adults Oncology, Institut Curie; and at the University Paris Descartes, Paris, France
| | - Andre Baruchel
- Department of Paediatric Haematology, Hôpital Robert Debré, AP-HP; and at the University Paris Diderot, Paris, France
| | - Josef Vormoor
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University; and at the Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Michela Casanova
- Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefan M Pfister
- German Cancer Research Center (DKFZ); German Cancer Consortium (DKTK); and at the Heidelberg University Hospital, Heidelberg, Germany
| | - Bruce Morland
- Department of Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - Gilles Vassal
- Department of Clinical Research, Gustave Roussy, Paris-Sud University, Paris, France
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23
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Brok J, Pritchard-Jones K, Geller JI, Spreafico F. Review of phase I and II trials for Wilms' tumour - Can we optimise the search for novel agents? Eur J Cancer 2017; 79:205-213. [PMID: 28521171 DOI: 10.1016/j.ejca.2017.04.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/08/2017] [Accepted: 04/08/2017] [Indexed: 11/29/2022]
Abstract
Survival rates for patients with Wilms' tumour (WT) approximate 90% with refined use of currently available interventions. However, a subgroup of patients, with initial high-risk histopathology or relapsing disease, have a poor prognosis, and it is a challenge to identify and prioritise the development of new innovative approaches for these subgroups. We conducted a systematic literature search for published phase I and II clinical trials that registered patients with WTs and characterised the early phase trial activity, quantified response rates and highlighted avenues for further development. We identified 63 trials (48 phase I, three phase I/II, and 12 phase II trials) enrolling 214 patients with WTs, alongside other malignancies. The number of annually recruited WTs did not change significantly and was less than 20% of the potential candidates. The vast majority of the trials were conducted in North America, and 56 different interventions were investigated, including conventional chemotherapy and biologically targeted therapies. Overall, 33 WTs revealed some degree of tumour control. Of these, five patients demonstrated complete remission (2%), 15 patients partial response (7%) and 13 patients stable disease (6%). None of the included novel biologically targeted therapies emerged as promising interventions, and only conventional chemotherapy was able to induce a complete and partial response. We conclude that early phase trial recruitment of WTs is below expected levels, and the clinical outcome of the included patients is dismal. Improvement of the availability and recruitment to early phase trials for WTs, especially in Europe, is needed.
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Affiliation(s)
- Jesper Brok
- University College London, Great Ormond Street Institute of Child Health, UK; Department of Paediatric Haematology and Oncology, Rigshospitalet, Copenhagen University Hospital, Denmark.
| | | | - James I Geller
- Division of Pediatric Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Filippo Spreafico
- Department of Hematology and Pediatric Onco-Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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24
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Pearson ADJ, Pfister SM, Baruchel A, Bourquin JP, Casanova M, Chesler L, Doz F, Eggert A, Geoerger B, Jones DTW, Kearns PR, Molenaar JJ, Morland B, Schleiermacher G, Schulte JH, Vormoor J, Marshall LV, Zwaan CM, Vassal G. From class waivers to precision medicine in paediatric oncology. Lancet Oncol 2017; 18:e394-e404. [PMID: 28677575 DOI: 10.1016/s1470-2045(17)30442-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/02/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Abstract
New drugs are crucially needed for children with cancer. The European Paediatric Regulation facilitates paediatric class waivers for drugs developed for diseases only occurring in adults. In this Review, we retrospectively searched oncology drugs that were class waivered between June, 2012, and June, 2015. 147 oncology class waivers were confirmed for 89 drugs. Mechanisms of action were then assessed as potential paediatric therapeutic targets by both a literature search and an expert review. 48 (54%) of the 89 class-waivered drugs had a mechanisms of action warranting paediatric development. Two (2%) class-waivered drugs were considered not relevant and 16 (18%) required further data. In light of these results, we propose five initiatives: an aggregated database of paediatric biological tumour drug targets; molecular profiling of all paediatric tumours at diagnosis and relapse; a joint academic-pharmaceutical industry preclinical platform to help analyse the activity of new drugs (Innovative Therapy for Children with Cancer Paediatric Preclinical Proof-of-Concept Platform); paediatric strategy forums; and the suppression of article 11b of the European Paediatric Regulation, which allows product-specific waivers on the grounds that the associated condition does not occur in children. These initiatives and a mechanism of action-based approach to drug development will accelerate the delivery of new therapeutic drugs for front-line therapy for those children who have unmet medical needs.
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Affiliation(s)
- Andrew D J Pearson
- Paediatric Drug Development, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK; Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK.
| | - Stefan M Pfister
- Division of Pediatric Neuro-oncology, German Cancer Research Center, Heidelberg, Germany; German Cancer Consortium, Heidelberg, Germany; Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andre Baruchel
- Pediatric Hematology-Immunology Department, University Hospital Robert Debré and Paris Diderot University, Paris, France
| | - Jean-Pierre Bourquin
- Division of Oncology and Hematology, University Children's Hospital Zurich, Children's Research Center, Zurich, Switzerland
| | - Michela Casanova
- Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Louis Chesler
- Paediatric Drug Development, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK; Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK
| | - François Doz
- Department of Paediatric, Adolescents and Young Adults Oncology and INSERM U830, Institut Curie, Paris, France
| | - Angelika Eggert
- Department of Pediatric Oncology and Hematology, Charité University Hospital, Berlin, Germany; German Cancer Consortium, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Birgit Geoerger
- Department of Pediatric and Adolescent Oncology, CNRS UMR 8203 Vectorology and Anticancer Treatments, Gustave Roussy, Université Paris-Sud, Villejuif, France
| | - David T W Jones
- Division of Pediatric Neuro-oncology, German Cancer Research Center, Heidelberg, Germany; German Cancer Consortium, Heidelberg, Germany
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Jan J Molenaar
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Bruce Morland
- Department of Paediatric Oncology, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Gudrun Schleiermacher
- Department of Paediatric, Adolescents and Young Adults Oncology and INSERM U830, Institut Curie, Paris, France
| | - Johannes H Schulte
- Department of Pediatric Oncology and Hematology, Charité University Hospital, Berlin, Germany; German Cancer Consortium, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Josef Vormoor
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University and Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lynley V Marshall
- Paediatric Drug Development, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK; Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK
| | - C Michel Zwaan
- Department of Pediatric Oncology/Hematology, Erasmus MC/Sophia Children's Hospital, Rotterdam, Netherlands; Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Gilles Vassal
- Department of Clinical Research, Gustave Roussy, Paris-Sud University, Paris, France
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25
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Bautista F, Gallego S, Cañete A, Mora J, Díaz de Heredia C, Cruz O, Fernández JM, Rives S, Berlanga P, Hladun R, Juan Ribelles A, Madero L, Ramírez M, Fernández Delgado R, Pérez-Martínez A, Mata C, Llort A, Martín Broto J, Cela ME, Ramírez G, Sábado C, Acha T, Astigarraga I, Sastre A, Muñoz A, Guibelalde M, Moreno L. [Early clinical trials in paediatric oncology in Spain: a nationwide perspective]. An Pediatr (Barc) 2017; 87:155-163. [PMID: 28279690 DOI: 10.1016/j.anpedi.2016.07.007] [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: 07/12/2016] [Accepted: 07/24/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cancer is the leading cause of death between the first year of life and adolescence, and some types of diseases are still a major challenge in terms of cure. There is, therefore, a major need for new drugs. Recent findings in cancer biology open the door to the development of targeted therapies against individual molecular changes, as well as immunotherapy. Promising results in adult anti-cancer drug development have not yet been translated into paediatric clinical practice. A report is presented on the activity in early paediatric oncology trials (phase I-II) in Spain. MATERIAL AND METHODS All members of the Spanish Society of Paediatric Haematology Oncology (SEHOP) were contacted in order to identify early clinical trials in paediatric cancer opened between 2005 and 2015. RESULTS A total of 30 trials had been opened in this period: 21 (70%) in solid tumours, and 9 (30%) in malignant haemopathies. A total of 212 patients have been enrolled. The majority was industry sponsored (53%). Since 2010, four centres have joined the international consortium of Innovative Therapies for Children with Cancer (ITCC), which has as its aim to develop novel therapies for paediatric tumours. A significant number of new studies have opened since 2010, improving the treatment opportunities for our children. Results of recently closed trials show the contribution of Spanish investigators, the introduction of molecularly targeted agents, and their benefits. CONCLUSIONS The activity in clinical trials has increased in the years analysed. The SEHOP is committed to develop and participate in collaborative academic trials, in order to help in the advancement and optimisation of existing therapies in paediatric cancer.
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Affiliation(s)
- Francisco Bautista
- Unidad de Investigación Clínica CNIO-HNJ, Servicio de Hematología, Oncología y Trasplante de Progenitores Hematopoyéticos, Hospital Infantil Universitario Niño Jesús, Madrid, España.
| | - Soledad Gallego
- Unidad de Oncología Pediátrica, Hospital Vall d'Hebron, Barcelona, España
| | - Adela Cañete
- Unidad de Oncología Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Jaume Mora
- Unidad de Oncología Pediátrica, Hospital Sant Joan de Déu, Barcelona, España
| | | | - Ofelia Cruz
- Unidad de Oncología Pediátrica, Hospital Sant Joan de Déu, Barcelona, España
| | - José María Fernández
- Unidad de Oncología Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Susana Rives
- Unidad de Oncología Pediátrica, Hospital Sant Joan de Déu, Barcelona, España
| | - Pablo Berlanga
- Unidad de Oncología Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Raquel Hladun
- Unidad de Oncología Pediátrica, Hospital Vall d'Hebron, Barcelona, España
| | - Antonio Juan Ribelles
- Unidad de Oncología Pediátrica, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Luis Madero
- Unidad de Investigación Clínica CNIO-HNJ, Servicio de Hematología, Oncología y Trasplante de Progenitores Hematopoyéticos, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Manuel Ramírez
- Unidad de Investigación Clínica CNIO-HNJ, Servicio de Hematología, Oncología y Trasplante de Progenitores Hematopoyéticos, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | | | | | - Cristina Mata
- Unidad de Oncología Pediátrica, Hospital Gregorio Marañón, Madrid, España
| | - Anna Llort
- Unidad de Oncología Pediátrica, Hospital Vall d'Hebron, Barcelona, España
| | | | - María Elena Cela
- Unidad de Oncología Pediátrica, Hospital Gregorio Marañón, Madrid, España
| | - Gema Ramírez
- Unidad de Oncología Pediátrica, Hospital Virgen del Rocío, Sevilla, España
| | - Constantino Sábado
- Unidad de Oncología Pediátrica, Hospital Vall d'Hebron, Barcelona, España
| | - Tomás Acha
- Unidad de Oncología Pediátrica, Hospital Carlos Haya, Málaga, España
| | - Itziar Astigarraga
- Unidad de Oncología Pediátrica, Hospital Universitario Cruces, Barakaldo, IIS BioCruces, Universidad del País Vasco (UPV/EHU), España
| | - Ana Sastre
- Unidad de Oncología Pediátrica, Hospital La Paz, Madrid, España
| | - Ascensión Muñoz
- Unidad de Oncología Pediátrica, Hospital Miguel Servet, Zaragoza, España
| | - Mercedes Guibelalde
- Unidad de Oncología Pediátrica, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - Lucas Moreno
- Unidad de Investigación Clínica CNIO-HNJ, Servicio de Hematología, Oncología y Trasplante de Progenitores Hematopoyéticos, Hospital Infantil Universitario Niño Jesús, Madrid, España; Instituto de Investigación La Princesa, Madrid, España
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Ferrari A, Schneider DT, Bisogno G, Orbach D, Villarroel M, Giron V, Rodriguez-Galindo C, Sorbara S, Magni C, Chiaravalli S, Casanova M, Cecchetto G, Godzinski J, Bien E, Stachowicz-Stencel T, Brennan B, Reguerre Y, Sultan I, Brecht IB. The challenge of very rare childhood cancers in developed and developing countries. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1298440] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Gianni Bisogno
- Hematology-Oncology Division, Department of Pediatrics, Padova University Hospital, Padova, Italy
| | - Daniel Orbach
- Department of Pediatrics, Adolescent and Young Adult Oncology, Institut Curie, Paris, France
| | | | - Veronica Giron
- National Pediatric Oncology Unit/Unidad Nacional de Oncologia Pediatrica, Guatemala City, Guatemala
| | | | - Silvia Sorbara
- Hematology-Oncology Division, Department of Pediatrics, Padova University Hospital, Padova, Italy
| | - Chiara Magni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giovanni Cecchetto
- Pediatric Surgery, Department of Pediatrics, Padova University Hospital, Padova, Italy
| | - Jan Godzinski
- Department of Pediatric Surgery, Marciniak Hospital, Wroclaw, Poland
| | - Ewa Bien
- Department of Pediatrics, Medical University, Gdansk, Poland
| | | | - Bernadette Brennan
- Department of Pediatric Oncology, Royal Manchester Children’s Hospital, Manchester, UK
| | - Yves Reguerre
- Pediatric Hematology-Oncology Department, Centre Hospitalier Universitaire, Angers, France
| | - Iyad Sultan
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Ines B. Brecht
- Pediatric Hematology and Oncology, University of Tuebingen, Tuebingen, Germany
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27
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Dauti A, Gerstl B, Chong S, Chisholm O, Anazodo A. Improvements in Clinical Trials Information Will Improve the Reproductive Health and Fertility of Cancer Patients. J Adolesc Young Adult Oncol 2017; 6:235-269. [PMID: 28207285 DOI: 10.1089/jayao.2016.0084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
There are a number of barriers that result in cancer patients not being referred for oncofertility care, which include knowledge about reproductive risks of antineoplastic agents. Without this information, clinicians do not always make recommendations for oncofertility care. The objective of this study was to describe the level of reproductive information and recommendations that clinicians have available in clinical trial protocols regarding oncofertility management and follow-up, and the information that patients may receive in clinical trials patient information sheets or consent forms. A literature review of the 71 antineoplastic drugs included in the 68 clinical trial protocols showed that 68% of the antineoplastic drugs had gonadotoxic animal data, 32% had gonadotoxic human data, 83% had teratogenic animal data, and 32% had teratogenic human data. When the clinical trial protocols were reviewed, only 22% of the protocols reported the teratogenic risks and 32% of the protocols reported the gonadotoxic risk. Only 56% of phase 3 protocols had gonadotoxic information and 13% of phase 3 protocols had teratogenic information. Nine percent of the protocols provided fertility preservation recommendations and 4% provided reproductive information in the follow-up and survivorship period. Twenty-six percent had a section in the clinical trials protocol, which identified oncofertility information easily. When gonadotoxic and teratogenic effects of treatment were known, they were not consistently included in the clinical trial protocols and the lack of data for new drugs was not reported. Very few protocols gave recommendations for oncofertility management and follow-up following the completion of cancer treatment. The research team proposes a number of recommendations that should be required for clinicians and pharmaceutical companies developing new trials.
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Affiliation(s)
- Angela Dauti
- 1 College of Arts and Sciences, Department of Chemistry, New York University , New York City, New York.,2 Population Sciences Department, Dana-Farber Cancer Institute , Boston, Massachusetts.,3 Department of Women's and Children's Medicine, School of Medical Sciences, University of New South Wales , Sydney, Australia
| | - Brigitte Gerstl
- 4 Kids Cancer Centre, Sydney Children's Hospital , Sydney, Australia
| | - Serena Chong
- 3 Department of Women's and Children's Medicine, School of Medical Sciences, University of New South Wales , Sydney, Australia
| | - Orin Chisholm
- 5 Department of Pharmaceutical Medicine, School of Medical Sciences, University of New South Wales , Sydney, Australia
| | - Antoinette Anazodo
- 3 Department of Women's and Children's Medicine, School of Medical Sciences, University of New South Wales , Sydney, Australia .,4 Kids Cancer Centre, Sydney Children's Hospital , Sydney, Australia .,6 Nelune Comprehensive Cancer Centre, Prince of Wales Hospital , Randwick, Australia
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28
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Carceller F, Bautista FJ, Jiménez I, Hladun-Álvaro R, Giraud C, Bergamaschi L, Dandapani M, Aerts I, Doz F, Frappaz D, Casanova M, Morland B, Hargrave DR, Marshall LV, Vassal G, Pearson AD, Geoerger B, Moreno L. Prognostic factors of overall survival in children and adolescents enrolled in dose-finding trials in Europe: An Innovative Therapies for Children with Cancer study. Eur J Cancer 2016; 67:130-140. [DOI: 10.1016/j.ejca.2016.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/29/2016] [Accepted: 08/14/2016] [Indexed: 10/21/2022]
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van der Geest IM, van den Heuvel-Eibrink MM, Zwaan CM, Pieters R, Passchier J, Darlington ASE. Participation in a clinical trial for a child with cancer is burdensome for a minority of children. Acta Paediatr 2016; 105:1100-4. [PMID: 26991953 DOI: 10.1111/apa.13405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/02/2016] [Accepted: 03/11/2016] [Indexed: 11/27/2022]
Abstract
AIM This study explored how parents who had lost a child to cancer felt about them taking part in a clinical trial. METHODS A retrospective questionnaire was sent to parents who had lost a child to cancer. They were asked whether their child took part in a clinical trial during their palliative phase, their motives for their child's participation, how they perceived their child's burden and whether they would, hypothetically speaking, enrol again. RESULTS The 24 parents of 16 deceased children who had participated in a clinical trial explained their motives for their child's participation. The most common answers, with multiple responses, were treatment for future patients (n = 16), hope for a cure (n = 9) and prolonging their child's life (n = 6). Eight parents said that participating was not burdensome for their child and four said it was very burdensome, with others answering in between. None of the parents would decline participation if they would be in the same situation again. CONCLUSION Performing clinical trials, even in a vulnerable population, such as children with cancer at the end of life, may not always lead to increased burden. None of the parents would in future, given the same circumstances, decline participation in a clinical trial.
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Affiliation(s)
- Ivana M.M. van der Geest
- Department of Paediatric Oncology/Haematology; Erasmus MC-Sophia Children's Hospital; Rotterdam Netherlands
- Princess Maxima Centre for Paediatric Oncology; Utrecht Netherlands
| | | | - C. Michel Zwaan
- Department of Paediatric Oncology/Haematology; Erasmus MC-Sophia Children's Hospital; Rotterdam Netherlands
| | - Rob Pieters
- Princess Maxima Centre for Paediatric Oncology; Utrecht Netherlands
| | - Jan Passchier
- Department of Clinical Psychology; VU University Amsterdam; Amsterdam Netherlands
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30
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Landscape of early clinical trials for childhood and adolescence cancer in Spain. Clin Transl Oncol 2015; 18:708-13. [DOI: 10.1007/s12094-015-1421-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/25/2015] [Indexed: 12/26/2022]
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31
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Ferrari A, Chiaravalli S, Casanova M, Gasparini P, Corradini N, Orbach D. Considering chemotherapy in synovial sarcoma. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1076723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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32
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Hirsch S, Marshall LV, Carceller Lechon F, Pearson ADJ, Moreno L. Targeted approaches to childhood cancer: progress in drug discovery and development. Expert Opin Drug Discov 2015; 10:483-95. [DOI: 10.1517/17460441.2015.1025745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Commentary on: "The response and survival of children with recurrent diffuse intrinsic pontine glioma based on phase II study of antineoplastons A10 and AS2-1 in patients with brainstem glioma." By Burzynski et al. Childs Nerv Syst 2014; 30:2071-2. [PMID: 25330863 DOI: 10.1007/s00381-014-2557-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022]
Abstract
A potential effective therapy for diffuse intrinsic pontine glioma (DIPG) is far to be developed. There are no "shortcuts" to reach this goal. Only a rigid, scientific, and ethically correct approach can help develop effective therapeutic approaches for such a devastating brain tumor. There are no alternative ways. The children affected by DIPG deserve to become the focus of serious collaborative researches. For these children, there are many "lacks" which should be promptly corrected such as the lack of knowledge, the lack of basic and clinical scientists' passion to the problem of finding "the solution" for DIPG, the lack of rigid methods to run research in this frustrating field, the lack of research proposals, and the lack of serious, despite not magic, protocols to offer them.
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Adamson PC, Houghton PJ, Perilongo G, Pritchard-Jones K. Drug discovery in paediatric oncology: roadblocks to progress. Nat Rev Clin Oncol 2014; 11:732-9. [PMID: 25223555 PMCID: PMC4637819 DOI: 10.1038/nrclinonc.2014.149] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Approval of new cancer drugs for paediatric patients generally occurs after their development and approval for treating adult cancers. As most drug development occurs in the industry setting, the relatively small market of paediatric oncology does not provide the financial incentives for companies to actively pursue paediatric oncology solutions. Indeed, between 1948 and January 2003 the FDA approved 120 new cancer drugs, of which only 30 have been used in children. This slow rate of development must be addressed in a meaningful way if we are to make progress in the most pressing settings in childhood cancer. In this Viewpoint article, the key opinion leaders in the field weigh in and offer practical advice on how to address this issue.
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Affiliation(s)
- Peter C Adamson
- The Children's Hospital of Philadelphia, 3501 Civic Center Boulevard, CTRB 10060, Philadelphia, PA 19104, USA
| | - Peter J Houghton
- The Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | | | - Kathy Pritchard-Jones
- Institute of Child Health, Cancer Section, University College London, 30 Guilford Street, London WC1N 1EH, UK
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35
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Vassal G, Rousseau R, Blanc P, Moreno L, Bode G, Schwoch S, Schrappe M, Skolnik J, Bergman L, Bradley-Garelik MB, Saha V, Pearson A, Zwierzina H. Creating a unique, multi-stakeholder Paediatric Oncology Platform to improve drug development for children and adolescents with cancer. Eur J Cancer 2014; 51:218-24. [PMID: 25434924 DOI: 10.1016/j.ejca.2014.10.029] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 10/28/2014] [Indexed: 11/26/2022]
Abstract
Seven years after the launch of the European Paediatric Medicine Regulation, limited progress in paediatric oncology drug development remains a major concern amongst stakeholders - academics, industry, regulatory authorities, parents, patients and caregivers. Restricted increases in early phase paediatric oncology trials, legal requirements and regulatory pressure to propose early Paediatric Investigation Plans (PIPs), missed opportunities to explore new drugs potentially relevant for paediatric malignancies, lack of innovative trial designs and no new incentives to develop drugs against specific paediatric targets are some unmet needs. Better access to new anti-cancer drugs for paediatric clinical studies and improved collaboration between stakeholders are essential. The Cancer Drug Development Forum (CDDF), previously Biotherapy Development Association (BDA), with Innovative Therapy for Children with Cancer Consortium (ITCC), European Society for Paediatric Oncology (SIOPE) and European Network for Cancer Research in Children and Adolescents (ENCCA) has created a unique Paediatric Oncology Platform, involving multiple stakeholders and the European Union (EU) Commission, with an urgent remit to improve paediatric oncology drug development. The Paediatric Oncology Platform proposes to recommend immediate changes in the implementation of the Regulation and set the framework for its 2017 revision; initiatives to incentivise drug development against specific paediatric oncology targets, and repositioning of drugs not developed in adults. Underpinning these changes is a strategy for mechanism of action and biology driven selection and prioritisation of potential paediatric indications rather than the current process based on adult cancer indications. Pre-competitive research and drug prioritisation, early portfolio evaluation, cross-industry cooperation and multi-compound/sponsor trials are being explored, from which guidance for innovative trial designs will be provided.
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Affiliation(s)
- Gilles Vassal
- Department of Clinical Research, Institut Gustave Roussy, Paris-Sud University, Paris, France.
| | | | - Patricia Blanc
- Imagine for Margo, 9 Avenue Eric Tabarly, 78112 Fourqueux, France.
| | - Lucas Moreno
- CNIO Centro Nacional de Investigaciones Oncológicas, C/ Melchor Fernández Almagro, 3, E-28029 Madrid, Spain.
| | - Gerlind Bode
- International Confederation of Childhood Cancer Parent Organizations, Schouwstede 2B, 3431 JB Nieuwegein, The Netherlands.
| | - Stefan Schwoch
- Eli Lilly, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey GU20 6PH, UK.
| | - Martin Schrappe
- Department of General Pediatrics, Christian-Albrechts-University and Medical Centre Schleswig-Holstein, Campus Kiel, Schwanenweg 20, D-24105 Kiel, Germany.
| | - Jeffrey Skolnik
- GlaxoSmithKline, 5 Crescent Drive, Philadelphia, PA 19112, USA.
| | - Lothar Bergman
- Medizinische Klinik II, J.W. Goethe Universität, D-60590 Frankfurt, Germany.
| | | | - Vaskar Saha
- Institute of Cancer Sciences, The University of Manchester, Manchester Academic Health Science Centre, 550 Wilmslow Rd, Manchester M20 4BX, UK.
| | - Andy Pearson
- The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, 15 Cotswold Road, Sutton, London SM2 5NG, UK.
| | - Heinz Zwierzina
- Medizinische Universität Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
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36
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Sosnik A, Carcaboso AM. Nanomedicines in the future of pediatric therapy. Adv Drug Deliv Rev 2014; 73:140-61. [PMID: 24819219 DOI: 10.1016/j.addr.2014.05.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 04/16/2014] [Accepted: 05/01/2014] [Indexed: 01/02/2023]
Abstract
Nanotechnology has become a key tool to overcome the main (bio)pharmaceutical drawbacks of drugs and to enable their passive or active targeting to specific cells and tissues. Pediatric therapies usually rely on the previous clinical experience in adults. However, there exists scientific evidence that drug pharmacokinetics and pharmacodynamics in children differ from those in adults. For example, the interaction of specific drugs with their target receptors undergoes changes over the maturation of the different organs and systems. A similar phenomenon is observed for toxicity and adverse effects. Thus, it is clear that the treatment of disease in children cannot be simplified to the direct adjustment of the dose to the body weight/surface. In this context, the implementation of innovative technologies (e.g., nanotechnology) in the pediatric population becomes extremely challenging. The present article overviews the different attempts to use nanotechnology to treat diseases in the pediatric population. Due to the relevance, though limited available literature on the matter, we initially describe from preliminary in vitro studies to preclinical and clinical trials aiming to treat pediatric infectious diseases and pediatric solid tumors by means of nanotechnology. Then, the perspectives of pediatric nanomedicine are discussed.
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Affiliation(s)
- Alejandro Sosnik
- Department of Materials Science and Engineering, Technion-Israel Institute of Technology, Technion City, Haifa 32000, Israel.
| | - Angel M Carcaboso
- Preclinical Therapeutics and Drug Delivery Research Program, Department of Oncology, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona 08950, Spain
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37
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Bourquin JP, Bornhauser B. Have chemosensitizing strategies for multidrug-resistant childhood acute lymphoblastic leukemia come of age? Expert Rev Hematol 2014; 3:369-72. [DOI: 10.1586/ehm.10.39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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38
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Yilmaz MC, Sari HY, Cetingul N, Kantar M, Erermis S, Aksoylar S. Determination of School-Related Problems in Children Treated for Cancer. J Sch Nurs 2013; 30:376-84. [DOI: 10.1177/1059840513506942] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This descriptive and case–control study was carried out in a pediatric oncology outpatient clinic to determine the school-related physical, social, and psychological problems and problems experienced in academic achievement of children treated for cancer. The sample of the study consisted of 56 Turkish patients with cancer, aged 7–18 years, who were in remission and attending school as well as their parents, a control group of patients who did not have cancer, and their teachers. A Child Information Form, a Child Health Questionnaire Parent’s Form of 50 questions, a Behavior Evaluation Scale for Children, and Young People and a Teacher’s Report Form were used as data collection tools in the study. Of the children, 30.3% experienced various physical difficulties stemming from cancer therapy that affected their school life. The number of late enrollments, the number of children repeating a grade, and the rates of school absenteeism were also found to be higher in the survivors than in the controls.
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Affiliation(s)
- Medine C. Yilmaz
- Nursing Department, Health Sciences Faculty, Izmir Katip Celebi University, Izmir, Turkey
| | - Hatice Yildirim Sari
- Nursing Department, Health Sciences Faculty, Izmir Katip Celebi University, Izmir, Turkey
| | - Nazan Cetingul
- Pediatric Oncology Department, Ege University Faculty of Medicine, Izmir, Turkey
| | - Mehmet Kantar
- Pediatric Oncology Department, Ege University Faculty of Medicine, Izmir, Turkey
| | - Serpil Erermis
- Child Psychiatric Department, Ege University Faculty of Medicine, Izmir, Turkey
| | - Serap Aksoylar
- Pediatric Oncology Department, Ege University Faculty of Medicine, Izmir, Turkey
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39
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Zwaan CM, Rizzari C, Mechinaud F, Lancaster DL, Lehrnbecher T, van der Velden VH, Beverloo BB, den Boer ML, Pieters R, Reinhardt D, Dworzak M, Rosenberg J, Manos G, Agrawal S, Strauss L, Baruchel A, Kearns PR. Dasatinib in Children and Adolescents With Relapsed or Refractory Leukemia: Results of the CA180-018 Phase I Dose-Escalation Study of the Innovative Therapies for Children With Cancer Consortium. J Clin Oncol 2013; 31:2460-8. [DOI: 10.1200/jco.2012.46.8280] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Dasatinib is a potent BCR-ABL inhibitor with proven efficacy in adults with newly diagnosed chronic myeloid leukemia (CML) in chronic phase (CP) and in imatinib-resistant/intolerant disease. This phase I study of the Innovative Therapies for Children with Cancer Consortium assessed dasatinib safety and efficacy in pediatric patients. Patients and Methods Escalating once-daily dasatinib doses (60 to 120 mg/m2) were administered to children (n = 58) with (i) imatinib-pretreated CML or Philadelphia chromosome (Ph)–positive acute lymhoblastic leukemia (ALL) and (ii) treatment-refractory Ph-negative ALL or acute myeloid leukemia (AML). Results Dasatinib safety and efficacy profiles compared favorably with those in adults. The most common drug-related nonhematologic adverse events were nausea (31%, all grades; 2%, grade 3 to 4), headache (22%, 3%), diarrhea (21%, 0%), and vomiting (17%, 2%). Of 17 patients with CML-CP, 14 (82%) achieved complete cytogenetic response (CCyR) and eight (47%) achieved major molecular response. After ≥ 24 months of follow-up, median complete hematologic response (CHR) and major cytogenetic response (MCyR) durations were not reached. Of 17 patients with advanced-phase CML or Ph-positive ALL, six (35%) achieved confirmed CHR and 11 (65%) achieved CCyR. Median MCyR duration was 4.6 months (95% CI, 2.1 to 17.4 months). No patient with Ph-negative ALL or AML responded. Dasatinib pediatric pharmacokinetic parameters were comparable with those in adult studies, showing rapid absorption (time to reach maximum concentration, 0.5 to 6.0 hours) and elimination (mean half-life, 3.0 to 4.4 hours). Conclusion Dasatinib 60 mg/m2 and 80 mg/m2 once-daily dosing were selected for phase II studies in children with Ph-positive leukemias.
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Affiliation(s)
- C. Michel Zwaan
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Carmelo Rizzari
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Francoise Mechinaud
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Donna L. Lancaster
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Thomas Lehrnbecher
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Vincent H.J. van der Velden
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - B. Berna Beverloo
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Monique L. den Boer
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Rob Pieters
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Dirk Reinhardt
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Michael Dworzak
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Julie Rosenberg
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - George Manos
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Shruti Agrawal
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Lewis Strauss
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - André Baruchel
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Pamela R. Kearns
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
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Relapse in medulloblastoma: what can be done after abandoning high-dose chemotherapy? A mono-institutional experience. Childs Nerv Syst 2013; 29:1107-12. [PMID: 23595805 DOI: 10.1007/s00381-013-2104-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 04/04/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE We retrospectively report strategies used for medulloblastoma patients progressing after craniospinal irradiation where we aimed for: symptom control, a satisfactory quality of life, accrual in phase 1-2 trials, when available, and the first two conditions could no longer be satisfied by already experienced second-line strategies. METHODS Surgery was used in cases of doubtful relapse or when only one site was affected. Radiotherapy was given whenever possible, especially to relieve symptoms. The main chemotherapy regimens were oral temozolomide/etoposide, intravenous (iv.) cisplatin/etoposide, iv. gemcitabine/oxaliplatin, an oral sonic hedgehog pathway inhibitor and oral melphalan. RESULTS Between 1998 and 2011, we treated 18 patients relapsed after median 20 months. Nine had relapsed locally, four had dissemination, three single metastases, and two had one synchronous local and metastatic recurrence. Responses to chemotherapy were seen in 32% of cases. The median hospital stay for treatments/complications was 19 days. The 1- and 3-year progression-free survival (PFS) rates were 28 ± 10% and 0%, respectively, for OS, they were 44 ± 12% and 22 ± 10% but no patient was cured. The median PFS after a first relapse was 7 months (range 1-29); the median OS was 7 months (range 4-44). No patients died due to treatment toxicity. Late recurrence (more than 1-2 years after diagnosis) and involvement of single sites were favorable prognostic factors. CONCLUSIONS Without succeeding in patients cure, we ensured them further treatment with short hospital stay thus affording low personal and social costs. The chances of cure may emerge from tailored therapies according to genetic stratification.
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Scherzinger-Laude K, Schönherr C, Lewrick F, Süss R, Francese G, Rössler J. Treatment of neuroblastoma and rhabdomyosarcoma using RGD-modified liposomal formulations of patupilone (EPO906). Int J Nanomedicine 2013; 8:2197-211. [PMID: 23818777 PMCID: PMC3693827 DOI: 10.2147/ijn.s44025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Patupilone (EPO906) is a microtubule stabilizer with a potent antitumor effect. Integrin αVβ3-binding (RGD) liposomes were loaded with EPO906, and their antitumor efficacy was evaluated in two pediatric tumor models, ie, neuroblastoma and rhabdomyosarcoma. Methods Integrin αVβ3 gene expression, RGD-liposome cellular association, and the effect of EPO906 and liposomal formulations of EPO906 on cell viability were assessed in vitro in human umbilical vein endothelial cells (HUVEC), in the RH-30 rhabdomyosarcoma cell line, and in the Kelly neuroblastoma cell line. In vivo, mice bearing neuroblastoma or rhabdomyosarcoma tumors were treated with EPO906, EPO906-liposomes, or EPO906-RGD-liposomes. Tumor growth, cumulative survival, and toxicity were monitored. Results Integrin αVβ3 was highly expressed in HUVEC and RH-30, but not in Kelly cells. Accordingly, RGD-liposomes were highly associated with HUVEC and RH-30 cells in vitro, but not with the Kelly cells. EPO906 and its liposomal formulations inhibited HUVEC, RH-30, and Kelly cell viability to the same extent. In vivo, EPO906 1.5 mg/kg and liposomal EPO906 potently inhibited tumor growth in both xenograft models without triggering major toxicity. At this dose, liposomal EPO906 did not enhance the antitumor effect of EPO906 in neuroblastoma, but tended to have an increased antitumor effect in rhabdomyosarcoma. Using a lower dose of EPO906-RGD-liposomes significantly enhanced cumulative survival in rhabdomyosarcoma compared with EPO906 alone. Conclusion EPO906 shows a strong antitumor effect in neuroblastoma and rhabdomyosarcoma, without triggering major side effects. Its liposomal encapsulation does not alter its activity, and enhances cumulative survival when EPO906-RGD-liposomes are used at low dose in rhabdomyosarcoma.
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Affiliation(s)
- Karine Scherzinger-Laude
- Clinic IV, Pediatric Hematology and Oncology, Center of Pediatrics and Adolescent Medicine, University Medical Hospital Freiburg, Germany
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Vassal G, Zwaan CM, Ashley D, Le Deley MC, Hargrave D, Blanc P, Adamson PC. New drugs for children and adolescents with cancer: the need for novel development pathways. Lancet Oncol 2013; 14:e117-24. [PMID: 23434337 DOI: 10.1016/s1470-2045(13)70013-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Despite major progress in the past 40 years, 20% of children with cancer die from the disease, and 40% of survivors have late adverse effects. Innovative, safe, and effective medicines are needed. Although regulatory initiatives in the past 15 years in the USA and Europe have been introduced, new drug development for children with cancer is insufficient. Children and families face major inequity between countries in terms of access to innovative drugs in development. Hurdles and bottlenecks are well known-eg, small numbers of patients, the complexity of developing targeted agents and their biomarkers for selected patients, limitations of US and EU regulations for paediatric medicines, insufficient return on investment, and the global economic crisis facing drug companies. New drug development pathways could efficiently address the challenges with innovative methods and trial designs, investment in biology and preclinical research, new models of partnership and funding including public-private partnerships and precompetitive research consortia, improved regulatory requirements, initiatives and incentives that better address these needs, and increased collaboration between paediatric oncology cooperative groups worldwide. Increased cooperation between all stakeholders-academia, parents' organisations and advocacy groups, regulatory bodies, pharmaceutical companies, philanthropic organisations, and government-will be essential.
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Affiliation(s)
- Gilles Vassal
- Division of Clinical Research, Institut Gustave Roussy, Paris-Sud University, Paris, France.
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Sullivan R, Kowalczyk JR, Agarwal B, Ladenstein R, Fitzgerald E, Barr R, Steliarova-Foucher E, Magrath I, Howard SC, Kruger M, Valsecchi MG, Biondi A, Grundy P, Smith MA, Adamson P, Vassal G, Pritchard-Jones K. New policies to address the global burden of childhood cancers. Lancet Oncol 2013; 14:e125-35. [PMID: 23434339 DOI: 10.1016/s1470-2045(13)70007-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Childhood cancer is a major global health issue. Every year, almost 100 000 children die from cancer before the age of 15 years, more than 90% of them in resource-limited countries. Here, we review the key policy issues for the delivery of better care, research, and education of professionals and patients. We present a key list of time-limited proposals focusing on change to health systems and research and development. These include sector and system reforms to make care affordable to all, policies to promote growth of civil society around both cancer and Millennium Development Goals, major improvements to public health services (particularly the introduction of national cancer plans), improved career development, and increased remuneration of specialist health-care workers and government support for childhood cancer registries. Research and development proposals focus on sustainable funding, the establishment of more research networks, and clinical research specifically targeted at the needs of low-income and middle-income countries. Finally, we present proposals to address the need for clinical trial innovation, the complex dichotomy of regulations, and the threats to the availability of data for childhood cancers.
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Affiliation(s)
- Richard Sullivan
- Institute of Cancer Policy, King's Health Partners Integrated Cancer Centre, London, UK.
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Vassal G, Geoerger B, Morland B. Is the European Pediatric Medicine Regulation Working for Children and Adolescents with Cancer? Clin Cancer Res 2013; 19:1315-25. [DOI: 10.1158/1078-0432.ccr-12-2551] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ramelet AS, Wosinski J, Feltin E, Mabire C, Rapin J. A systematic review of the effectiveness of therapeutic education for children diagnosed with cancer and their families on behavioural and health-related outcomes. ACTA ACUST UNITED AC 2013. [DOI: 10.11124/jbisrir-2013-608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Stanulla M, Bourquin JP. [Treatment of acute lymphoblastic leukemia in childhood: state of things and outlook for the future]. ACTA ACUST UNITED AC 2012; 41:203-13. [PMID: 22844667 DOI: 10.1002/pauz.201200469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Martin Stanulla
- Kinderklinik am Universitätsklinikum, Schleswig-Holstein, Campus Kiel, Kiel.
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Sosnik A, Seremeta KP, Imperiale JC, Chiappetta DA. Novel formulation and drug delivery strategies for the treatment of pediatric poverty-related diseases. Expert Opin Drug Deliv 2012; 9:303-23. [PMID: 22257003 DOI: 10.1517/17425247.2012.655268] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Due to a lack of approved drugs and formulations, children represent the most vulnerable patients. Magistral, unlicensed formulations obtained by the manipulation of solid forms should undergo clinical evaluation to ensure bioequivalence. The development of new pediatric medicines is complex and faces technological, economic and ethical challenges. This phenomenon has contributed to the emergence of an adult-children gap. To improve the situation, the World Health Organization launched the global campaign 'Make medicines child size' and a number of international initiatives have been established. The situation is more critical in the case of poverty-related diseases (PRDs) that mainly affect poor countries. AREAS COVERED This review critically discusses different strategies to develop pediatric formulations and drug delivery systems (DDS) in PRDs and their potential implementation in the current market. Readers will gain an updated perspective on the development of pediatric medicines for the treatment of PRDs and the proximate challenges and opportunities faced to ensure an effective pharmacotherapy. EXPERT OPINION There is an urgent need for the development of innovative, scalable and cost-viable formulations to ensure pediatric patients have access to appropriate medications for PRDs. The guidelines of the International Conference on Harmonisation constitute a very good orientation tool, as they emphasize physiological and developmental aspects that need to be considered in pediatric research. It is important to consider cultural, economic and ethical aspects that make developing nations facing PRDs different from the developed world. Thus, the best strategy would probably be to conceive and engage similar initiatives in the developing world, to address unattended therapeutic niches.
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Affiliation(s)
- Alejandro Sosnik
- University of Buenos Aires, Faculty of Pharmacy and Biochemistry, Department of Pharmaceutical Technology, The Group of Biomaterials and Nanotechnology for Improved Medicines, 956 Junín St., Buenos Aires CP1113, Argentina.
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Rengaswamy V, Kontny U, Rössler J. New approaches for pediatric rhabdomyosarcoma drug discovery: targeting combinatorial signaling. Expert Opin Drug Discov 2011; 6:1103-25. [PMID: 22646865 DOI: 10.1517/17460441.2011.611498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Rhabdomyosarcomas (RMS) are rare heterogeneous pediatric tumors that are treated by surgery, chemotherapy and irradiation. New therapeutic approaches are needed, especially in the advanced stages to target the pro-oncogenic signals. Exploring the molecular interactions of the regulatory signals and their roles in the developmental aspects of different subtypes of RMS is essential to identify potential targets and develop new therapeutic drugs. AREAS COVERED Insights into different drug discovery approaches are discussed with specific emphasis on gene expression profiling, fusion protein, role of small interfering RNA (siRNA)- and microRNA (miRNA)-based discovery approaches, targeting cancer stem cells, and in vitro and in vivo model systems. Targeting some overexpressed signals along with the possibilities of combination therapy of validated drug targets is discussed. Additionally, methods to overcome the limitations of discovery-based research are briefly discussed. EXPERT OPINION Due to drug resistance, ineffective therapy in advanced stages and relapse, there is a demand to explore new drug targets and discovery approaches. Implementing miRNA-based profiling would reveal the extent of miR-based regulation, various biomarkers and potential targets in RMS. A suitable combination of innovative techniques and the use of model systems might assist the identification and validation of novel targets and drug discovery methods. Combining specific drugs along with type-specific target inhibition of overexpressed mRNAs through siRNA approaches would enable the development of personalized therapy.
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Affiliation(s)
- Venkatesh Rengaswamy
- University Hospital Freiburg, Center for Pediatrics and Adolescent Medicine, Clinic IV: Pediatric Hematology and Oncology, Mathildenstr. 1, 79106 Freiburg , Germany +49 761 270 43000 ; +49 761 270 45180 ;
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[Indications and current development of new targeted therapies in pediatric oncology]. Bull Cancer 2011; 98:527-39. [PMID: 21596652 DOI: 10.1684/bdc.2011.1358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Progresses performed in pediatric oncology during the last 30 years allowed to obtain about 70 to 80% healing rates. These progresses are the result of the optimization of the cytotoxic chemotherapies protocols used at standard and high doses, as well as the improvement of the local treatment. Most of the new anticancer treatments currently in developmental stage are based on targeted therapies, acting against numerous tumor cell abnormalities, like growth factors et their receptors, cell proliferation-inducing factors, molecules involved in DNA repair, cell death inducers, tumor invasion and angiogenesis. They are widely used in adult patients since 10 years and they are being more and more employed in children with cancer. The aim of this article is to review the main indications of these new targeted drugs in pediatric oncology and the new developments of these drugs.
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Early phase drugs and biologicals clinical trials on worldwide leading causes of death: a descriptive analysis. Eur J Clin Pharmacol 2011; 67:563-71. [PMID: 21465293 DOI: 10.1007/s00228-011-1036-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 03/11/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To describe the global effort targeting the major causes of mortality in terms of "open" early phase clinical trials with drugs and biologicals. METHODS Sixteen of the 20 leading causes of death were chosen; 9 of these were also amongst the top 10 causes of death in low-income countries. Studies were identified from the ClinicalTrials.gov database and included phase 1 and/or 2 "interventional" "open" trials, i.e. those recruiting or about to start recruitment. Trials were considered in terms of sponsorship [industry, universities and other organisations (UNO), and US federal agencies (NIH included)], genders and age groups included, and whether they were conducted with drugs and/or biologicals. The search was performed in March 2010. RESULTS A total of 2,298 (824 phase 1; 1,474 phase 2) trials were retrieved. Of these, 67% were on trachea, bronchus, and lung cancers (25%); diabetes mellitus (15%); colon and rectum cancers (14%); and HIV/AIDS (12%). In contrast, only 4% were trials on diarrhoeal disease, nephrosis and nephritis, liver cirrhosis, and prematurity and low birth weight. UNO were the first source of funding. Fifty-two percent of phase 1 non-cancer trials were on healthy volunteers. Twenty-nine percent of all trials were co-funded. There were 4.6 times as many drug trials as those with biologicals. Only 7% were conducted with a combination of drugs and biologicals, the majority (78%) on cancers. Discrimination in terms of gender or age group was not observed. CONCLUSIONS Four of the 16 diseases considered represented 2/3 of early phase trials. Cancers were a top priority for all sponsors. Increasing attention should be given to conditions with current and projected global high mortality rates that had few "open" early phase trials.
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