Children Older Than 1 Year With Metastatic Neuroblastoma - Essay Example

Consolidation Treatment With Chimeric Anti-GD2-Antibody ch14.18 in Children Older Than Year With Metastatic Neuroblastoma Simon, T., Hero, B., Faldum, A., Handgretinger, R., Schrappe, M., Niethammer, D., et al. (2004). Journal of Clinical Oncology, Vol 22, No 17, pp. 3549-3557 Abstract The impact of antibody treatment was analyzed in neuroblastoma patients older than a year who have already undergone ineffectual initial treatments. Two groups of patients were given a ch14.18 treatment and a low-dose maintenance chemotherapy treatment, respectively.

A third group which serves as a control received no additional treatments. Side effects were substantial but are manageable. These include fever (55%), abnormal C-reactive protein (35%), cough (24%), rashes (22%), and pain (16%). Through multivariate analysis, it has been demonstrated that the ch14.18 antibody treatment has no clear advantage against other treatments on the patients event-free and overall survival. Introduction Today, patients suffering from metastatic neuroblastoma still have a poor chance of recovery, thus the potential of new treatments such as the use of antibodies are being explored in addition to more traditional methods.

Initial clinical tests of ch14.18 against the ganglioside GD2 in neuroblastoma cells were encouraging, therefore trials including high-risk patients were proceeded. Pathophysiology The ganglioside GD2 is a glycosphingolipid present on neuroblastoma cells, as well as on solid tumor, brain, and peripheral nerve cells. Monoclonal antibodies such as ch14.18 directed against GD2 have recently become available, and their potential for use in neuroblastoma cells were recognized. Treatment 334 patients were used and given the following treatments: 166 received ch14.

18; 99 received low-dose maintenance chemotherapy (MT); and 69 had no additional treatment. A 20 mg/m2/d dose of ch14.18 was administered during 5 days in six cycles every 2 months. Toxicity The 695 assessable cycles administered to the patients were analyzed for toxicity. Common toxicity symptoms were fever (55% of all cycles), C-reactive protein elevation without evidence of infection (35%), treatment-resistant dry cough (24%), urticarial skin rash (22%), and tolerable pain despite prophylactic analgesia, commonly in in the back or the abdomen (16%).

There are less common effects, but those are not likely related to the antibody itself. Results and Discussion A comparison of the event-free survival (EFS) and overall survival (OS) of patients who received MAB ch14.18 and those who underwent the 12-month maintenance chemotherapy, as well the control group, were assessed for outcome analysis. Univariate analysis found an advantage of ch14.18 treatment for OS but not for EFS, while multivariate analysis the treatment has not revealed any clear advantage.

A difference between the two analysis for OS may indicate some long-term benefit from the treatment if the disease recurs. Conclusion It is imperative that efforts must be carried out to conceive of treatment methods that increase the likelihood of survival for neuroblastoma patients. Although the results from this study caused the treatments for ch14.18 to be discontinued, I believe there is still room for more research. Other studies conducted wherein ch14.18 was administered with a higher dosage through a shorter period of time showed promising results.

Also, the analysis of the study did not evaluate other factors that might influence the clinical effect, and this might be a viable point for research later on . Bibliography Simon, T., Hero, B., Faldum, A., Handgretinger, R., Schrappe, M., Niethammer, D., et al. (2004). “Consolidation Treatment With Chimeric Anti-GD2-Antibody ch14.18 in Children Older Than 1 Year With Metastatic Neuroblastoma”. Journal of Clinical Oncology, Vol 22, No 17, pp. 3549-3557.