- Neuroblastoma: 1 | 2 | 3 | 4 | 5 | Fish and (gene) Chips
Tactics on trial
To make further gains, physicians will need to move beyond the brute-force assault of toxic drugs and radiation, turning to newer weapons that are more specific and less harmful to the body. Advancing this line of research is where Shusterman puts much of her time and energy. When she joined the Dana-Farber/Children's neuroblastoma program, she also became the principal investigator in Boston for NANT – New Approaches in Neuroblastoma Therapy – a collaboration of 14 universities and children's medical centers carrying out clinical trials of a variety of agents.
Patients with advanced neuroblastoma require expert, specialized treatment with surgery, chemotherapy, radiation, and blood stem cell transplants.
One of the promising avenues being tested is shrinking tumors by choking off their blood supply with antiangiogenesis agents. Two such drugs, temozolomide and thalidomide, have been used in neuroblastoma, and the new angiogenesis inhibitor Avastin is under consideration for testing. A different type of drug, topotecan, prevents breaks in cancer cells' DNA from being repaired, thereby causing the cells to die. It has proved surprisingly effective in relapsed neuroblastoma, and a trial of the drug as a first-line treatment in newly diagnosed patients is being planned.
Another line of attack uses a targeted "search-and-destroy" strategy to deliver radiation directly to neuroblastoma cells. For example, a drug called MIBG is preferentially taken up by neuroblastoma tissue, and four medical centers in the United States are treating the tumors by linking radioactive iodine to MIBG, carrying targeted radiation to the neuroblastoma.
The treatment has few toxic side effects and in some studies has shrunk advanced tumors in 40 percent of relapsed patients. "These are very good results," says Shusterman, adding that more than three-quarters of patients get significant pain relief. She says she hopes the Dana-Farber/Children's program can begin offering the therapy this fall after construction of a special lead-lined treatment room.
Yet another "smart" weapon is an antibody called Hu14.18-IL2 that affixes to neuroblastoma cells and signals the patient's immune system to combat the cancer. A trial of this therapy has recently opened here. And one of the collaborative NANT studies is using cyclophosphamide, a chemotherapy agent, given in almost-constant small doses along with Zometa (zoledronic acid), an antiangiogenic drug that may help prevent a cancer from metastasizing (spreading) to the patient's bones.
- Next: A promising future
- Page: 1 | 2 | 3 | 4 | 5 | Fish and (gene) Chips
