Faster chemo technique increases survival in children with neuroblastoma

Chemotherapy given with shorter intervals between treatments than conventional chemotherapy increases survival rates by two thirds in children with high-risk neuroblastoma, according to a study published in the Lancet Oncology.

The ten year trial co-ordinated in six countries by scientists from the Children’s Cancer and Leukaemia Group (CCLG), funded by Cancer Research UK, studied the effects of administering chemotherapy every 10 rather than 21 days at 1.8 times the conventional dose on 262 children with neuroblastoma, a cancer of the special developing nerve cells.

They found five-year event-free survival rates increased by 12 per cent in the group with the rapid 10-day technique and a reduction in the time taken to move on to the next stage of treatment by 55 days. Survival in the rapid treatment group was 30.2 per cent, compared with 18.2 per cent in the standard treatment group.

Neuroblastoma affects around 90 children each year in the UK and the high-risk type of the disease is one of the main causes of cancer-related deaths in children. Researchers in this study treated children over the age of one with high-risk, stage four neuroblastoma – the most aggressive form of the disease.

Treatment for advanced neuroblastoma occurs in five phases. The first phase – an initial round of chemotherapy – is given every 21 days in the standard regimes. This is followed by surgery, high dose chemotherapy, radiotherapy and, finally, treatment with more drugs.

The results of this trial have led to the roll out of the more rapid chemotherapy method across Europe.

Professor Andy Pearson, lead author of the paper and Cancer Research UK’s professor of paediatric oncology at The Institute of Cancer Research and the Royal Marsden Hospital in Sutton, said: "Our method of chemotherapy increases the survival rates for children with high risk neuroblastoma and is already saving the lives of many children. Using a higher dose and having chemotherapy with shorter breaks between each treatment means that fewer children will die from the disease each year.

"This step forward in the treatment of high risk neuroblastoma wouldn’t have been possible without the help of the parents of the children involved in the trial.

"Our study is the foundation of the current European study of high-risk neuroblastoma, which has already recruited over 10,000 children and investigates new therapies, hoping to improve further the outcome of these children. In the future, improvements will occur by developing new anti-cancer drugs which we are doing at The Institute of Cancer Research."

Dr Bruce Morland, chairman of the CCLG, said: "This type of chemotherapy is a much better building block for this most severe form of neuroblastoma compared to conventional methods. Thanks to this study, children across Europe with this type of cancer will now receive more intensive therapy early in their treatment and have a significantly greater chance to survive their battle against the disease."

Kate Law, Cancer Research UK’s director of clinical trials, said: "On the strength of the results of this trial, all children in Europe will receive a more effective treatment for this disease. Overall survival rates for children’s cancers have been rapidly improving, but it’s crucial we support trials like this that tackle the challenge of advanced cancer."

(Source: Lancet Oncology: Cancer Research UK: March 2008)