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Moreno L, Caron H, Geoerger B, Eggert A, Schleiermacher G, Brock P, Valteau-Couanet D, Chesler L, Schulte JH, De Preter K, Molenaar J, Schramm A, Eilers M, Van Maerken T, Johnsen JI, Garrett M, George SL, Tweddle DA, Kogner P, Berthold F, Koster J, Barone G, Tucker ER, Marshall L, Herold R, Sterba J, Norga K, Vassal G, Pearson AD. Accelerating drug development for neuroblastoma - New Drug Development Strategy: an Innovative Therapies for Children with Cancer, European Network for Cancer Research in Children and Adolescents and International Society of Paediatric Oncology Europe Neuroblastoma project. Expert Opin Drug Discov 2017; 12:801-811. [PMID: 28604107 DOI: 10.1080/17460441.2017.1340269] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Neuroblastoma, the commonest paediatric extra-cranial tumour, remains a leading cause of death from cancer in children. There is an urgent need to develop new drugs to improve cure rates and reduce long-term toxicity and to incorporate molecularly targeted therapies into treatment. Many potential drugs are becoming available, but have to be prioritised for clinical trials due to the relatively small numbers of patients. Areas covered: The current drug development model has been slow, associated with significant attrition, and few new drugs have been developed for neuroblastoma. The Neuroblastoma New Drug Development Strategy (NDDS) has: 1) established a group with expertise in drug development; 2) prioritised targets and drugs according to tumour biology (target expression, dependency, pre-clinical data; potential combinations; biomarkers), identifying as priority targets ALK, MEK, CDK4/6, MDM2, MYCN (druggable by BET bromodomain, aurora kinase, mTORC1/2) BIRC5 and checkpoint kinase 1; 3) promoted clinical trials with target-prioritised drugs. Drugs showing activity can be rapidly transitioned via parallel randomised trials into front-line studies. Expert opinion: The Neuroblastoma NDDS is based on the premise that optimal drug development is reliant on knowledge of tumour biology and prioritisation. This approach will accelerate neuroblastoma drug development and other poor prognosis childhood malignancies.
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Affiliation(s)
- Lucas Moreno
- a Paediatric Phase I-II Clinical Trials Unit, Paediatric Haematology & Oncology , Hospital Niño Jesus , Madrid , Spain
- b Instituto de Investigación Sanitaria La Princesa , Madrid , Spain
- c Paediatric Drug Development, Children and Young People's Unit , Royal Marsden Hospital , London , UK
| | - Hubert Caron
- d Emma Children's Hospital , Amsterdam , Netherlands
- e Hoffman-La Roche , Basel , Switzerland
| | - Birgit Geoerger
- f Department of Paediatric and Adolescent Oncology , Institut Gustave Roussy , Villejuif , France
| | - Angelika Eggert
- g Department of Pediatric Oncology and Hematology , Charite University Hospital , Berlin , Germany
| | - Gudrun Schleiermacher
- h Department of Paediatric, Adolescents and Young Adults Oncology and INSERM U830 , Institut Curie , Paris , France
| | - Penelope Brock
- i Department Paediatric Oncology , Great Ormond Street Hospital , London , UK
| | | | - Louis Chesler
- c Paediatric Drug Development, Children and Young People's Unit , Royal Marsden Hospital , London , UK
- j Division of Clinical Studies , Institute of Cancer Research , London , UK
| | - Johannes H Schulte
- g Department of Pediatric Oncology and Hematology , Charite University Hospital , Berlin , Germany
| | | | - Jan Molenaar
- l Princess Maxima Center for Pediatric Oncology , University of Amsterdam , Amsterdam , Netherlands
| | - Alexander Schramm
- m Department of Pediatric Oncology , University of Essen , Essen , Germany
| | - Martin Eilers
- n Theodor Boveri Institute and Comprehensive Cancer Center Mainfranken, Biocenter , University of Wurzburg , Wurzburg , Germany
| | - Tom Van Maerken
- k Centre for Medical Genetic , Ghent University , Ghent , Belgium
| | - John Inge Johnsen
- o Department of Women's and Children's Health , Karolinska Institute , Stockholm , Sweden
| | | | - Sally L George
- c Paediatric Drug Development, Children and Young People's Unit , Royal Marsden Hospital , London , UK
- j Division of Clinical Studies , Institute of Cancer Research , London , UK
| | - Deborah A Tweddle
- q Wolfson Childhood Cancer Research Centre , Newcastle University , Newcastle , UK
| | - Per Kogner
- o Department of Women's and Children's Health , Karolinska Institute , Stockholm , Sweden
| | - Frank Berthold
- r Department of Pediatric Oncology and Hematology , University of Cologne , Cologne , Germany
| | - Jan Koster
- l Princess Maxima Center for Pediatric Oncology , University of Amsterdam , Amsterdam , Netherlands
| | - Giuseppe Barone
- c Paediatric Drug Development, Children and Young People's Unit , Royal Marsden Hospital , London , UK
- j Division of Clinical Studies , Institute of Cancer Research , London , UK
| | - Elizabeth R Tucker
- c Paediatric Drug Development, Children and Young People's Unit , Royal Marsden Hospital , London , UK
- j Division of Clinical Studies , Institute of Cancer Research , London , UK
| | - Lynley Marshall
- c Paediatric Drug Development, Children and Young People's Unit , Royal Marsden Hospital , London , UK
- j Division of Clinical Studies , Institute of Cancer Research , London , UK
| | | | - Jaroslav Sterba
- t Masaryk University, University Hospital , Brno , Czech Republic
- u Department of Pediatric Oncology , International Clinical Research Center, St. Anne's University Hospital , Brno , Czech Republic
- v RECAMO, Masaryk Memorial Cancer Centre , Brno , Czech Republic
| | - Koen Norga
- w Pediatric Hematology/Oncology Unit , Antwerp University Hospital , Antwerp , Belgium
| | - Gilles Vassal
- x Department of Clinical Research, Gustave Roussy , Paris-Sud University , Paris , France
| | - Andrew Dj Pearson
- c Paediatric Drug Development, Children and Young People's Unit , Royal Marsden Hospital , London , UK
- j Division of Clinical Studies , Institute of Cancer Research , London , UK
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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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Jamin Y, Tucker ER, Poon E, Popov S, Vaughan L, Boult JKR, Webber H, Hallsworth A, Baker LCJ, Jones C, Koh DM, Pearson ADJ, Chesler L, Robinson SP. Evaluation of clinically translatable MR imaging biomarkers of therapeutic response in the TH-MYCN transgenic mouse model of neuroblastoma. Radiology 2013; 266:130-40. [PMID: 23169794 PMCID: PMC4298658 DOI: 10.1148/radiol.12120128] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate noninvasive and clinically translatable magnetic resonance (MR) imaging biomarkers of therapeutic response in the TH-MYCN transgenic mouse model of aggressive, MYCN-amplified neuroblastoma. MATERIALS AND METHODS All experiments were performed in accordance with the local ethical review panel and the UK Home Office Animals Scientific Procedures Act 1986 and with the UK National Cancer Research Institute guidelines for the welfare of animals in cancer research. Multiparametric MR imaging was performed of abdominal tumors found in the TH-MYCN model. T2-weighted MR imaging, quantitation of native relaxation times T1 and T2, the relaxation rate R2*, and dynamic contrast-enhanced MR imaging were used to monitor tumor response to cyclophosphamide (25 mg/kg), the vascular disrupting agent ZD6126 (200 mg/kg), or the antiangiogenic agent cediranib (6 mg/kg, daily). Any significant changes in the measured parameters, and in the magnitude of the changes after treatment between treated and control cohorts, were identified by using Student two-tailed paired and unpaired t test, respectively, with a 5% level of significance. RESULTS Treatment with cyclophosphamide or cediranib induced a 54% or 20% reduction in tumor volume at 48 hours, respectively (P < .005 and P < .005, respectively; P < .005 and P < .005 versus control, respectively). Treatment with ZD6126 induced a 45% reduction in mean tumor volume 24 hours after treatment (P < .005; P < .005 versus control). The antitumor activity of cyclophosphamide, cediranib, and ZD6126 was consistently associated with a decrease in tumor T1 (P < .005, P < .005, and P < .005, respectively; P < .005, P < .005, and P < .005 versus control, respectively) and with a correlation between therapy-induced changes in native T1 and changes in tumor volume (r = 0.56; P < .005). Tumor response to cediranib was also associated with a decrease in the dynamic contrast-enhanced MR imaging-derived volume transfer constant (P = .07; P < .05 versus control) and enhancing fraction (P < .05; P < .01 versus control), and an increase in R2* (P < .005; P < .05 versus control). CONCLUSION The T1 relaxation time is a robust noninvasive imaging biomarker of response to therapy in tumors in TH-MYCN mice, which emulate high-risk neuroblastoma in children. T1 measurements can be readily implemented on clinical MR systems and should be investigated in translational clinical trials of new targeted therapies for pediatric neuroblastoma. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12120128/-/DC1.
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Affiliation(s)
- Yann Jamin
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, 15 Cotswold Road, Sutton, Surrey SM2 5NG, England.
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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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