Professor Zhen Zijun: Progress in maintenance treatment of high-risk neuroblastoma

Foreword September 25-26, 2021, co-sponsored by the Pediatric Oncology Committee of the Guangdong Anti-Cancer Association and the Pediatric Oncology Committee of the Chinese Anti-Cancer Association, and organized by the Department of Pediatric Oncology, Sun Yat-sen University Cancer Center The meeting will be held in Guangzhou by a combination of online and offline
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Many experts and scholars in the field of oncology gathered to discuss the treatment and development of childhood tumors
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During the conference, Yimaitong invited Professor Zhen Zijun from the Child Oncology Department of Sun Yat-sen University Cancer Center to share the progress of maintenance treatment for high-risk neuroblastoma
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Expert ProfileProfessor Zhen Zijun, Chief Physician, Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Chief Physician, Doctor of Medicine, Master's Tutor, Deputy Chairman and Secretary, Pediatric Oncology Committee, Guangdong Anti-Cancer Association, Deputy Director, Pediatric Hematology Oncology Committee, Guangdong Society of Clinical Medicine, Guangdong Member of the Standing Committee and Secretary of the Hematology Management Branch of the Provincial Medical Industry Association Member of the Neuro-Oncology Professional Committee of the Guangdong Anti-Cancer Association and Deputy Leader of the Pediatric Brain Tumor Group Member of the Targeted and Individualized Therapy Professional Committee of the Guangdong Anti-Cancer Association Member of the Oncology Professional Committee Member of the Pediatric Oncology Committee of the Chinese Research Hospital Association Member of the Oncology Group of the Pediatric Branch of the Chinese Medical Association The difference is large, especially for high-risk neuroblastoma, and there are still great unmet clinical needs
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Could you please introduce, what are the treatments for high-risk neuroblastoma? Professor Yen Zijun: Neuroblastoma is the most common extracranial malignant tumor in children.
It is highly malignant and progresses quickly.
At the time of diagnosis, about 50% of them have metastasized
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The treatment of high-risk neuroblastoma includes four steps: induction therapy, local therapy, consolidation therapy and maintenance therapy
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Under normal circumstances, when a patient is diagnosed with a high-risk neuroblastoma, the tumor burden is already large and extensive.
Induction chemotherapy can reduce the tumor size and quickly improve the condition
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Local treatments can then be performed, including surgery and radiotherapy
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In the consolidation treatment stage, patients can receive autologous hematopoietic stem cell transplantation combined with super-high-dose chemotherapy to improve the efficacy of high-risk neuroblastoma
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The task of the final maintenance phase is to continuously monitor and eliminate small residual lesions
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These four links are indispensable in the treatment of high-risk neuroblastoma
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Yimaitong: Maintenance treatment of high-risk neuroblastoma helps to eliminate residual tumor cells
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Could you please talk about the recent developments in the maintenance treatment of neuroblastoma? Professor Yen Zijun: Maintenance therapy is very important in the treatment of high-risk neuroblastoma
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Through induction therapy, local therapy, and consolidation therapy, most patients' tumors have been completely relieved, but a small number of patients still have small residual lesions in their bodies.
These small lesions may lead to recurrence of the patient’s disease, and maintenance treatment helps to clear the small lesions.
, To reduce the possibility of recurrence
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The first drug used in maintenance therapy is retinoic acid, and its efficacy is relatively clear
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A new generation of differentiation-inducing agents that can be used in patients with resistance to retinoic acid also has a good effect
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In addition, the use of anti-ganglioside monoclonal antibodies, namely anti-GD2 monoclonal antibodies, can also obtain very clear therapeutic effects in maintenance therapy
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At present, according to the latest research progress published by some institutions, anti-polyamine therapy may achieve better curative effects, but this treatment method currently needs to be clarified by randomized controlled trials
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In addition, rhythm maintenance therapy, that is, multiple use of low-dose chemotherapeutic drugs, and different mechanisms of action of the drugs to remove small residual lesions also has a good prospect
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According to existing research, beat therapy can achieve the same curative effect as hematopoietic stem cell transplantation, and the treatment cost and treatment-related side effects are much lower than stem cell transplantation
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In addition, PD-1 monoclonal antibody, apatinib, MIBG and other drugs are currently in the scientific research stage and have not been widely used in clinical practice
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Yimaitong: What is the status and application prospect of immune maintenance therapy in the treatment of childhood neuroblastoma? What are the directions worth exploring in the future? Professor Zhen Zijun: At present, the most positive effect of immunotherapy for neuroblastoma is the anti-GD2 monoclonal antibody used in maintenance therapy
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Studies have shown that the use of anti-GD2 monoclonal antibody can increase the success rate of treatment by 20% compared to when it was not used
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In the induction treatment stage, whether the use of anti-GD2 monoclonal antibody combined with other chemotherapeutic drugs can improve the tumor remission rate, the ultimate cure rate, and whether it can increase the success rate of rescue treatment for relapsed and refractory patients is a direction worth exploring at present
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Recommended reading: Professor Zhang Yu: Key Points and Progress in Pathological Diagnosis of Child Solid Tumors The 16th Annual Pediatric Oncology Symposium was successfully held in Guangzhou by a combination of online and offline methods.
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