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Vastly Better Odds for Kids With Deadly Cancer

New Neuroblastoma Treatments Improve Survival Rate, Lessen Long-Term Harm

Intermediate-Risk Neuroblastoma: Less Treatment, Better Results

Patients with intermediate-risk neuroblastoma usually get nine or 10 months of intensive chemotherapy. It's a tough treatment that can damage the kidneys, cause hearing loss, or even cause other cancers to develop. But over 90% of these cancers can be cured.

Is all this risk really necessary? Matthay and colleagues thought not. They identified subsets of patients based on the biology of their cancers. Those with more favorable biology got only three months of chemotherapy, given in the clinic on an outpatient basis.

The kids still lost their hair and suffered side effects. But the treatment was much less brutal. And nearly all the kids -- 96% -- survived.

"We were very happy with this," Matthay says. "And in our new study, we're trying to give some patients only two cycles of chemo. And in the future, will decrease the number of patients who actually have surgery."

New Treatment for High-Risk Neuroblastoma

Patients with high-risk neuroblastoma usually undergo intensive chemotherapy followed by surgery. If this is successful, the patient then undergoes a bone-marrow transplant, using the patient's own stem cells to reconstitute the bone marrow. This is followed by six months of treatment with retinoic acid to wipe out any remaining cancer cells.

Even after this intensive treatment, more than half of patients eventually relapse and die.

University of California, San Diego researcher Alice L. Yu, MD, PhD, and colleagues tested a new approach in 226 patients with high-risk neuroblastoma.

After successful bone-marrow transplant, Yu and colleagues treated half the patients with standard therapy and half with a new monoclonal antibody developed at the National Cancer Institute. The antibody attaches to a marker on the outside of neuroblastoma cells and targets them for destruction by the immune system. At the same time, patients receive two treatments that boost immune responses.

The results were dramatic. Two-year survival free of cancer recurrence, death, or secondary cancer was 46% in the standard treatment group and 66% in the group getting the new treatment.

"This made a huge difference in overall survival and in event-free survival," Matthay says.

Even so, a third of patients still relapse -- an event that is almost always fatal.

"This is a very tough disease. It is hard to see a 2-year-old progress and die despite all these treatments," Matthay says. "We still have a ways to go. But someday we will get close to curing everyone."

Matthay says parents should know that kids with neuroblastoma need treatment at major cancer centers, where state-of-the-art care greatly improves their chances of survival.

Both studies appear in the Sept. 30 issue of the New England Journal of Medicine.

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