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Green D, van Ewijk R, Tirtei E, Andreou D, Baecklund F, Baumhoer D, Bielack SS, Botchu R, Boye K, Brennan B, Capra M, Cottone L, Dirksen U, Fagioli F, Fernandez N, Flanagan AM, Gambarotti M, Gaspar N, Gelderblom H, Gerrand C, Gomez-Mascard A, Hardes J, Hecker-Nolting S, Kabickova E, Kager L, Kanerva J, Kester LA, Kuijjer ML, Laurence V, Lervat C, Marchais A, Marec-Berard P, Mendes C, Merks JH, Ory B, Palmerini E, Pantziarka P, Papakonstantinou E, Piperno-Neumann S, Raciborska A, Roundhill EA, Rutkauskaite V, Safwat A, Scotlandi K, Staals EL, Strauss SJ, Surdez D, Sys GM, Tabone MD, Toulmonde M, Valverde C, van de Sande MA, Wörtler K, Campbell-Hewson Q, McCabe MG, Nathrath M. Biological Sample Collection to Advance Research and Treatment: A Fight Osteosarcoma Through European Research and Euro Ewing Consortium Statement. Clin Cancer Res 2024; 30:3395-3406. [PMID: 38869831 PMCID: PMC11334773 DOI: 10.1158/1078-0432.ccr-24-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/27/2024] [Accepted: 06/11/2024] [Indexed: 06/14/2024]
Abstract
Osteosarcoma and Ewing sarcoma are bone tumors mostly diagnosed in children, adolescents, and young adults. Despite multimodal therapy, morbidity is high and survival rates remain low, especially in the metastatic disease setting. Trials investigating targeted therapies and immunotherapies have not been groundbreaking. Better understanding of biological subgroups, the role of the tumor immune microenvironment, factors that promote metastasis, and clinical biomarkers of prognosis and drug response are required to make progress. A prerequisite to achieve desired success is a thorough, systematic, and clinically linked biological analysis of patient samples, but disease rarity and tissue processing challenges such as logistics and infrastructure have contributed to a lack of relevant samples for clinical care and research. There is a need for a Europe-wide framework to be implemented for the adequate and minimal sampling, processing, storage, and analysis of patient samples. Two international panels of scientists, clinicians, and patient and parent advocates have formed the Fight Osteosarcoma Through European Research consortium and the Euro Ewing Consortium. The consortia shared their expertise and institutional practices to formulate new guidelines. We report new reference standards for adequate and minimally required sampling (time points, diagnostic samples, and liquid biopsy tubes), handling, and biobanking to enable advanced biological studies in bone sarcoma. We describe standards for analysis and annotation to drive collaboration and data harmonization with practical, legal, and ethical considerations. This position paper provides comprehensive guidelines that should become the new standards of care that will accelerate scientific progress, promote collaboration, and improve outcomes.
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Affiliation(s)
- Darrell Green
- Biomedical Research Centre, Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
| | - Roelof van Ewijk
- Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Elisa Tirtei
- Pediatric Oncology, Regina Margherita Children’s Hospital, Turin, Italy.
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
| | - Dimosthenis Andreou
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria.
| | - Fredrik Baecklund
- Pediatric Oncology Unit, Karolinska University Hospital, Stockholm, Sweden.
| | - Daniel Baumhoer
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland.
| | - Stefan S. Bielack
- Center for Pediatric, Adolescent and Women’s Medicine, Klinikum Stuttgart—Olgahospital, Stuttgart Cancer Centre, Stuttgart, Germany.
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom.
| | - Kjetil Boye
- Department of Oncology, Oslo University Hospital, Oslo, Norway.
| | - Bernadette Brennan
- Paediatric Oncology, Royal Manchester Children’s Hospital, Central Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom.
| | - Michael Capra
- Haematology/Oncology, Children’s Health Ireland at Crumlin, Dublin, Ireland.
| | - Lucia Cottone
- Department of Pathology, UCL Cancer Institute, University College London, London, United Kingdom.
| | - Uta Dirksen
- Pediatrics III, West German Cancer Center, University Hospital Essen, German Cancer Consortium (DKTK) Site Essen, Cancer Research Center (NCT) Cologne-Essen, University of Duisburg-Essen, Essen, Germany.
| | - Franca Fagioli
- Pediatric Oncology, Regina Margherita Children’s Hospital, Turin, Italy.
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
| | - Natalia Fernandez
- Patient and Parent Advocacy Group, FOSTER, Washington, District of Columbia.
| | - Adrienne M. Flanagan
- Department of Pathology, UCL Cancer Institute, University College London, London, United Kingdom.
- Histopathology, The Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom.
| | - Marco Gambarotti
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Nathalie Gaspar
- Department of Oncology for Child and Adolescent, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France.
- U1015, Université Paris-Saclay, Villejuif, France.
| | - Hans Gelderblom
- Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Craig Gerrand
- Orthopaedic Oncology, The Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom.
| | - Anne Gomez-Mascard
- Department of Pathology, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France.
- EQ ONCOSARC, CRCT Inserm/UT3, ERL CNRS, Toulouse, France.
| | - Jendrik Hardes
- Tumour Orthopaedics, University Hospital Essen, German Cancer Consortium (DKTK) Site Essen, Cancer Research Center (NCT) Cologne-Essen, University of Duisburg-Essen, Essen, Germany.
| | - Stefanie Hecker-Nolting
- Center for Pediatric, Adolescent and Women’s Medicine, Klinikum Stuttgart—Olgahospital, Stuttgart Cancer Centre, Stuttgart, Germany.
| | - Edita Kabickova
- Paediatric Haematology and Oncology, University Hospital Motol, Prague, Czech Republic.
| | - Leo Kager
- Pediatrics, St Anna Children’s Hospital, Medical University Vienna, Vienna, Austria.
- St Anna Children’s Cancer Research Institute, Vienna, Austria.
| | - Jukka Kanerva
- Hematology-Oncology and Stem Cell Transplantation, HUS Helsinki University Hospital, New Children’s Hospital, Helsinki, Finland.
| | - Lennart A. Kester
- Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Marieke L. Kuijjer
- Computational Biology and Systems Medicine Group, Centre for Molecular Medicine Norway, University of Oslo, Oslo, Norway.
- Pathology, Leiden University Medical Center, Leiden, the Netherlands.
- Leiden Center for Computational Oncology, Leiden University Medical Center, Leiden, the Netherlands.
| | | | - Cyril Lervat
- Department of Pediatrics and AYA Oncology, Centre Oscar Lambret, Lille, France.
| | - Antonin Marchais
- Department of Oncology for Child and Adolescent, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France.
| | - Perrine Marec-Berard
- Institute of Hematology and Pediatric Oncology, Léon Bérard Center, Lyon, France.
| | - Cristina Mendes
- Portuguese Institute of Oncology of Lisbon, Lisbon, Portugal.
| | - Johannes H.M. Merks
- Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands.
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Benjamin Ory
- School of Medicine, Nantes Université, Nantes, France.
| | - Emanuela Palmerini
- Bone and Soft Tissue Sarcomas and Innovative Therapies Unit, IRCCS Istituto Orthopedico Rizzoli, Bologna, Italy.
| | - Pan Pantziarka
- Patient and Parent Advocacy Group, FOSTER, Washington, District of Columbia.
- Anticancer Fund, Meise, Belgium.
- The George Pantziarka TP53 Trust, London, United Kingdom.
| | - Evgenia Papakonstantinou
- Pediatric Hematology-Oncology, Ippokratio General Hospital of Thessaloniki, Thessaloniki, Greece.
| | | | - Anna Raciborska
- Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland.
| | - Elizabeth A. Roundhill
- Children’s Cancer Research Group, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom.
| | - Vilma Rutkauskaite
- Center for Pediatric Oncology and Hematology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
| | - Akmal Safwat
- The Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.
| | - Katia Scotlandi
- Laboratory of Experimental Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Eric L. Staals
- Orthopaedics and Trauma, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Sandra J. Strauss
- Department of Oncology, University College London Hospitals NHS Foundation Trust, UCL Cancer Institute, London, United Kingdom.
| | - Didier Surdez
- Balgrist University Hospital, Faculty of Medicine, University of Zurich (UZH), Zurich, Switzerland.
| | - Gwen M.L. Sys
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Belgium.
| | - Marie-Dominique Tabone
- Department of Hematology and Oncology, A. Trousseau Hospital, Sorbonne University, APHP, Paris, France.
| | - Maud Toulmonde
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France.
| | - Claudia Valverde
- Medical Oncology, Vall d’Hebron University Hospital, Barcelona, Spain.
| | | | - Klaus Wörtler
- Musculoskeletal Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Quentin Campbell-Hewson
- Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
| | - Martin G. McCabe
- Division of Cancer Sciences, School of Medical Sciences, The University of Manchester, Manchester, United Kingdom.
- The Christie NHS Foundation Trust, Manchester, United Kingdom.
| | - Michaela Nathrath
- Children’s Cancer Research Center, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
- Pediatric Oncology, Klinikum Kassel, Kassel, Germany.
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2
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De Wilde B, Barry E, Fox E, Karres D, Kieran M, Manlay J, Ludwinski D, Reaman G, Kearns P. The Critical Role of Academic Clinical Trials in Pediatric Cancer Drug Approvals: Design, Conduct, and Fit for Purpose Data for Positive Regulatory Decisions. J Clin Oncol 2022; 40:3456. [PMID: 35947814 DOI: 10.1200/jco.22.00033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/11/2022] [Accepted: 06/24/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE For decades, academic clinical trials consortia have collaborated to optimize outcomes for childhood cancers through evaluating incremental improvements in conventional mutimodality treatment regimes. There are now increasing opportunities to partner with industry to test new medicines in academic-sponsored trials, but these collaborative studies rarely contribute to marketing authorizations. We addressed why this is the case and sought solutions to enable academic-sponsored trials to directly contribute to the licensing of new medicines. METHODS Under the auspices of the multistakeholder platform ACCELERATE, we convened a working group of representatives from clinical academia, pharmaceutical industry, European Medicines Agency, US Food and Drug Administration, and patient advocacy to define the challenges and propose recommendations to facilitate academic-sponsored trial design and conduct to be aligned to both the needs of the pharmaceutical company who own the asset and the expectations of the regulatory (licensing) authorities. RESULTS We identified that although academic consortia have long-standing expertise to conduct robust clinical trials, there were critical gaps in knowledge, standard procedures, and resources that hindered the trial data directly contributing to marketing authorization applications. We propose a suite of recommendations focused on (1) essential documents, (2) essential data, (3) data management, and (4) trial resources, specifically aimed at enabling academic-industry partnerships to deliver an academic-sponsored trial that meets the requirements for a marketing authorization submission. These recommendations pivot around transparency in academic-industry partnerships and early engagement with regulators. CONCLUSION Academic sponsors and industry partners need to prospectively recognize when the planned collaborative trial could contribute to an application to marketing authorization and plan accordingly. Transparent collaboration and knowledge sharing between the partners opens an important pathway for accelerating new treatments into clinical practice for children with cancer.
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Affiliation(s)
- Bram De Wilde
- Department of Paediatric Haematology, Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent, Ghent University, Ghent, Belgium
| | - Elly Barry
- Day One Biopharmaceuticals Inc, San Francisco, CA
| | | | - Dominik Karres
- Human Medicines Division, Scientific Evidence Generation Department, Paediatric Medicines Office, European Medicines Agency (EMA), Amsterdam, the Netherlands
| | - Mark Kieran
- Day One Biopharmaceuticals Inc, San Francisco, CA
| | | | | | - Gregory Reaman
- Oncology Center of Excellence, Office of the Commissioner, and Office of Oncologic Diseases, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD
| | - Pamela Kearns
- Cancer Research UK Clinical Trials Unit, NIHR Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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3
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Vassal G, Houghton PJ, Pfister SM, Smith MA, Caron HN, Li XN, Shields DJ, Witt O, Molenaar JJ, Colombetti S, Schüler J, Stancato LF. International Consensus on Minimum Preclinical Testing Requirements for the Development of Innovative Therapies For Children and Adolescents with Cancer. Mol Cancer Ther 2021; 20:1462-1468. [PMID: 34108262 DOI: 10.1158/1535-7163.mct-20-0394] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 11/11/2020] [Accepted: 06/04/2021] [Indexed: 11/16/2022]
Abstract
Cancer remains the leading cause of disease-related death in children. For the many children who experience relapses of their malignant solid tumors, usually after very intensive first-line therapy, curative treatment options are scarce. Preclinical drug testing to identify promising treatment elements that match the molecular make-up of the tumor is hampered by the fact that (i) molecular genetic data on pediatric solid tumors from relapsed patients and thus our understanding of tumor evolution and therapy resistance are very limited to date and (ii) for many of the high-risk entities, no appropriate and molecularly well-characterized patient-derived models and/or genetic mouse models are currently available. However, recent regulatory changes enacted by the European Medicines Agency (class waiver changes) and the maturation of the RACE for Children act with the FDA, will require a significant increase in preclinical pediatric cancer research and clinical development must occur. We detail the outcome of a pediatric cancer international multistakeholder meeting whose output aims at defining an international consensus on minimum preclinical testing requirements for the development of innovative therapies for children and adolescents with cancer. Recommendations based on the experience of the NCI funded PPTP/C (www.ncipptc.org) and the EU funded ITCC-P4 public private partnership (www.itccp4.eu) are provided for the use of cell-based and mouse models for pediatric solid malignancies, as well as guidance on the scope and content of preclinical proof-of-concept data packages to inform clinical development dependent on clinical urgency. These recommendations can serve as a minimal guidance necessary to jumpstart preclinical pediatric research globally.
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Affiliation(s)
- Gilles Vassal
- Institute Gustave Roussy, Université Paris Saclay, Villejuif, France.
| | - Peter J Houghton
- Greehey Children's Cancer Research Institute, UT Health, San Antonio, Texas
| | - Stefan M Pfister
- Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK) and University Hospital, Heidelberg, Germany
| | - Malcolm A Smith
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
| | | | - Xiao-Nan Li
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - David J Shields
- Pfizer Centers for Therapeutic Innovation, Pfizer Inc., New York, New York
| | - Olaf Witt
- Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK) and University Hospital, Heidelberg, Germany
| | - Jan J Molenaar
- Princess Máxima Centrum for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Julia Schüler
- Charles River Discovery Research Services Germany, Freiburg, Germany
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5
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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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