Neuroblastoma: Therapeutic strategies for a clinical enigma Journal Article
| Authors: | Modak, S.; Cheung, N. K. V. |
| Article Title: | Neuroblastoma: Therapeutic strategies for a clinical enigma |
| Abstract: | Neuroblastoma, the most common extracranial pediatric solid tumor remains a clinical enigma with outcomes ranging from cure in >90% of patients with locoregional tumors with little to no cytotoxic therapy, to <30% for those >18. months of age at diagnosis with metastatic disease despite aggressive multimodality therapy. Age, stage and amplification of the MYCN oncogene are the most validated prognostic markers. Recent research has shed light on the biology of neuroblastoma allowing more accurate stratification of patients which has permitted reducing or withholding cytotoxic therapy without affecting outcome for low-risk patients. However, for children with high-risk disease, the development of newer therapeutic strategies is necessary. Current surgery and radiotherapy techniques in conjunction with induction chemotherapy have greatly reduced the risk of local relapse. However, refractory or recurrent osteomedullary disease occurs in most patients with high-risk neuroblastoma. Toxicity limits for high-dose chemotherapy appear to have been reached without further clinical benefit. Neuroblastoma is the first pediatric cancer for which monoclonal-antibody-based immunotherapy has been shown to be effective, particularly for metastatic osteomedullary disease. Radioimmunotherapy appears to be a critical component of a recent, successful regimen for treating patients who relapse in the central nervous system, a possible sanctuary site. Efforts are under way to refine and enhance antibody-based immunotherapy and to determine its optimal use. The identification of newer tumor targets and the harnessing of cell-mediated immunotherapy may generate novel therapeutic approaches. It is likely that a combination of therapeutic modalities will be required to improve survival and cure rates. © 2010. |
| Keywords: | event free survival; unclassified drug; overall survival; clinical trial; neutropenia; review; bevacizumab; cisplatin; doxorubicin; cancer combination chemotherapy; drug efficacy; drug safety; multimodality cancer therapy; drug targeting; cancer radiotherapy; radiation dose; rituximab; temozolomide; topotecan; cancer staging; neoplasm staging; diagnostic accuracy; t lymphocyte; tumor localization; carboplatin; cancer immunotherapy; drug eruption; pain; gene amplification; bone marrow suppression; dendritic cell; etoposide; thrombocytopenia; cyclophosphamide; immunoglobulin; vincristine; ifosfamide; irinotecan; monoclonal antibody; drug fever; gene expression regulation; chromosome aberration; hypotension; cancer regression; antibodies, monoclonal; immunotherapy; iodine 131; cancer vaccine; neuroblastoma; myc protein; 3-iodobenzylguanidine; natural killer cell; adoptive transfer; hyperbilirubinemia; drug bioavailability; (3 iodobenzyl)guanidine i 131; drug half life; hypothyroidism; retinol; angiogenesis inhibitors; anaphylaxis; therapy; autologous hematopoietic stem cell transplantation; perifosine; monoclonal antibody 3f8; zoledronic acid; recombinant interleukin 2; fenretinide; corticotropin; sialoadenitis; guanethidine |
| Journal Title: | Cancer Treatment Reviews |
| Volume: | 36 |
| ISSN: | 0305-7372 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2010-01-01 |
| Start Page: | 307 |
| End Page: | 317 |
| Language: | English |
| DOI: | 10.1016/j.ctrv.2010.02.006 |
| PUBMED: | 20227189 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 3" - "Export Date: 20 April 2011" - "CODEN: CTRED" - "Source: Scopus" |
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