{"id":1625,"date":"2021-02-04T15:43:10","date_gmt":"2021-02-04T15:43:10","guid":{"rendered":"http:\/\/horizon.peachpuff-wolverine-566518.hostingersite.com\/?p=1625"},"modified":"2021-02-04T15:43:10","modified_gmt":"2021-02-04T15:43:10","slug":"five-things-to-know-about-childhood-cancer","status":"publish","type":"post","link":"https:\/\/scienceblog.com\/horizon\/1625\/five-things-to-know-about-childhood-cancer\/","title":{"rendered":"Five things to know about childhood cancer"},"content":{"rendered":"
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Advances in diagnosis and care have yielded significant improvements in childhood cancer survival rates in Europe, but the long-term side-effect burden in young people \u2014\u202fdriven by the unlicensed use of adult cancer medicines \u2014\u202foften means the price of survival is high, scientists say.<\/strong><\/p>\n<\/div>\n<\/div>\n<\/div>\n

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Prescribing unlicensed drugs or the \u2018off-label\u2019 use of adult medicines for childhood cancer is largely the norm since the incidence of disease compared to adults is rare, which has disincentivised the biopharmaceutical industry from investing in paediatric research.<\/p>\n

Somehow, it has been widely accepted that it is standard for children with cancer to be treated with off-label adult drugs, says Prof. Ruth Ladenstein,\u202fproject coordinator of the European Reference Network on Paediatric Cancer\u00a0and a member of the EU\u2019s\u00a0cancer mission<\/a>\u00a0board (see box\u00a0below for more on the mission).<\/p>\n

\u2018If you go to through the scientific literature or online databases you can see numerous drugs that are undergoing testing in adults, but where children are excluded \u2026 and the major reason for this is that the industry doesn\u2019t see a market,\u2019 she said. \u2018It’s really high time \u2026 we get drugs that are better adjusted to age, and respective cancer types.\u2019<\/p>\n

Here are five things to know about the differences between adult and paediatric cancer, and how to better tackle the disease in children:<\/p>\n

1. Adult and childhood cancers are not the same<\/strong><\/p>\n

Environmental and lifestyle factors play a crucial role in the occurrence of cancer in adults \u2014 and making changes like reducing alcohol consumption, stopping smoking and eating healthy can diminish the incidence of fatal cancers in adults by up to 40%, says Prof. Ladenstein.<\/p>\n

But in children, environmental factors don\u2019t appear to have that kind of direct effect and only a minority of childhood cancers are driven by genetics. \u2018We have a suspicion that some environmental factors might play a role but in a very indirect way, but they are not translated as (a) one-to-one effect as we see it in adult cancers,\u2019 she said.<\/p>\n

Most childhood cancers tend to manifest in the first years of life and are far more aggressive than adult cancers, says Kjeld Schmiegelow, a professor of paediatrics at the University of Copenhagen, Denmark, who is advising the EU\u2019s cancer mission. \u2018The time from the first symptoms to diagnosis in most cases is relatively short. I mean we\u2019re talking about days or weeks or months here.\u2019<\/p>\n

Still, survival rates in children \u2014\u202fdespite the paucity of treatments tailored for younger age-groups \u2014\u202fis impressively high, with\u00a080% of patients disease-free after five years from diagnosis<\/a>\u00a0in high-income European countries. Currently, there are roughly\u00a0half a million childhood cancer survivors<\/a>\u00a0in Europe.<\/p>\n

In contrast, five-year survival rates for adult cancers are in the range of\u00a054.5%<\/a>\u00a0in Europe, but that percentage jumps higher in high-income countries in Western Europe.<\/p>\n

However, when a child has been declared disease-free \u2014\u202fif there’s no sign of malignancy five years after diagnosis they\u2019re very likely to be cured, says Prof. Schmiegelow. \u2018Adults\u2026they can relapse 5,10,15 years later.\u2019<\/p>\n

2. Medicines tested and approved for use in adults are the standard of care for childhood cancer<\/strong><\/p>\n

Each year in Europe there are\u00a035,000 new cases of cancer in children and adolescents<\/a>\u00a0\u2014\u202fthat figure rises substantially to\u00a03.7 million<\/a>\u00a0when adults are included.<\/p>\n

Given this large discrepancy, there are simply too few patients in the younger patient population to fuel industry interest, the scientists say. Of the 150 cancer medicines developed in the last decade,\u00a0only 9 have been approved for children<\/a>.<\/p>\n

Still, paediatric oncologists have done their best to run trials in academic institutions and tweak adult medicines to suit younger patients. Typically, the researchers test combinations and dosing strategies for chemotherapies that have been on the market for years but were never or not sufficiently tested in children.<\/p>\n

For adult drugs, academic institutions are usually contracted and paid to run trials initiated by a drug company. Apart from cases where pharmaceutical companies are requested to run trials in children by regulatory authorities, for paediatric cancers the onus of running trials is on independent oncologists.\u00a0Typically, the scientists contact the company and ask if they can secure trial supplies for free while the cost for running the trial and establishing necessary international networks depends on independent research foundations.<\/p>\n

\u2018It’s quite clear that that there’s a funding issue at hand (for paediatric trials),\u2019 said Prof. Schmiegelow, highlighting the need for academia, national policymakers and the industry to propel the development of age-appropriate paediatric cancer treatments.<\/p>\n

\u2018You can ask, is it really worthwhile putting so many resources into a rare disease \u2014\u202fand it is,\u2019 he said, pointing out that 1 in 5 childhood deaths is Europe is caused by cancer. \u2018If you look at the survival rates of children with cancer going back to 30 years and today, it’s getting better and better because of this huge academic effort.\u2019 But there are no continuously public funded systems supporting such international collaborations, he adds.<\/p>\n

3. Childhood cancer survival rates differ greatly between Eastern and Western Europe<\/strong><\/p>\n

Unfortunately, not all children benefit from the advances in cancer care \u2014\u202fin Eastern Europe, survival rates of childhood cancer are\u00a020% lower<\/a>\u00a0than the rest of Europe.<\/p>\n

Survival rates are tied to country-level health systems and national health budgets, so socio-economic differences between the East and the West are partly to blame, says Prof. Ladenstein. \u2018You need resources in terms of personnel to bring kids into trials,\u2019 she said. And you have to have all the drugs available to deliver the appropriate standard of cancer treatment, she adds.<\/p>\n

Essential drugs \u2014 such as chemotherapies which often serve as the backbone for cancer treatments \u2014 are not uniformly available across Europe, she says, acknowledging that parents have been known to “smuggle” drugs in from Western Europe to fill the gap.<\/p>\n

All treatment centres in Europe also need to be part of clinical trial cancer networks as this is where you learn to deal with therapy challenges such as insufficient efficacy of a treatment or serious toxicities \u2014\u00a0things like adjusting drug doses according to tolerance and knowing which combinations of drugs to use in poorly responding patients. That know-how that has been accumulated in the last few decades is often limited to physician networks across academic institutions that participate in a treatment trial, says Prof. Schmiegelow.<\/p>\n

\u2018It\u2019s not always written down \u2026 like a cooking recipe,\u2019 he explained. \u2018There’s no single thing that explains why we do so much better today. It’s thousands and thousands of pieces in the puzzle that has made the change.\u2019<\/p>\n

Eastern Europe will catch up as they begin partnering up with institutions in Western Europe, he predicted. \u2018I imagine that over the next 20 years you’ll see massive improvements in cure rates for Eastern Europe.\u2019<\/p>\n

4. A majority of childhood cancer survivors suffer from long-term side-effects<\/strong><\/p>\n

Driven by the off-label use of adult medicines,\u00a0two-thirds<\/a>\u00a0of all childhood cancer survivors experience long-term health issues.<\/p>\n

Some of these toxic side-effects are unacceptable \u2014\u202fbecause they have a significant effect on quality of life, says Prof. Schmiegelow. \u2018It may be massive cognitive disturbances, it may be that one of the organs is so damaged that they need an organ transplantation \u2026 in some cases, the price to cure is simply too high. And we don’t know today how to identify these patients.\u2019 \u2018It’s a real concern that requires a change,\u2019 said Prof. Ladenstein, noting that the issue is that most widely-used drugs have not been thoroughly tested in formal trials in children.<\/p>\n

It’s not only about the disease, or a type of\u00a0cancer \u2014 it’s also how to dose the drug from infancy up to adolescents and beyond, she says.<\/p>\n

5. To accelerate childhood cancer treatments, scientists must work alongside those developing new adult therapies<\/strong><\/p>\n

The majority of patients today are cured by conventional drugs and surgery, but new developments in immunotherapy are cause for optimism, scientists say.<\/p>\n

Prof. Ladenstein was part of the team that developed an immunotherapy that increased survival by 20% for patients with neuroblastoma, a rare form of childhood cancer that develops from immature nerve cells.<\/p>\n

\u2018I think there are still steps ahead, but the introduction of immunotherapy in the treatment of neuroblastoma was a major step forward,\u2019 she said.<\/p>\n

One way to accelerate the pace of research into childhood cancer treatments, she adds, is to work alongside researchers who have discovered fresh mechanisms of action to treat adult patients. For example, a lung cancer treatment that belongs to a family of drugs called ALK inhibitors\u202fwas latterly found to\u00a0help treat certain patients with neuroblastoma<\/a>.<\/p>\n

\u2018One can extrapolate similar modes of action, and potentially then benefit from common development at quite an early stage,\u2019 she said. \u2018I think we just have to play our cards much smarter in the future.\u2019<\/p>\n

If you liked this article, please consider sharing it on social media.<\/em><\/p>\n

The issue<\/em><\/h3>\n

Cancer is one of the leading causes of death for children in Europe, accounting for about\u00a0a quarter of childhood deaths between the ages of 5 and 14<\/a>.\u00a0The EU supports a number of research networks focused on childhood cancer, including\u00a0ENCCA<\/a>,\u00a0PanCareLife<\/a>,\u00a0PanCareFollowUP<\/a>,\u00a0ITCC-P4<\/a>\u00a0and others.<\/em><\/p>\n

Addressing cancer is one of the European Commission\u2019s five proposed \u2018missions\u2019, which are designed to deliver solutions to some of Europe\u2019s challenges over the next seven years. The aim of the mission, titled\u00a0Conquering Cancer: Mission Possible<\/a>, is to save more than 3 million lives by 2030. Among its goals is to reduce the burden of childhood cancer by improving the cures available.\u00a0<\/em><\/p>\n

On 3 February the European Commission also released its Beating Cancer Action Plan, which sets out concrete actions to reduce suffering caused by cancer and improve the lives of cancer patients and their families. It includes a focus on how to improve treatment and quality of life for cancer survivors \u2013 two critical issues for children with the disease.<\/em><\/p>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Advances in diagnosis and care have yielded significant improvements in childhood cancer survival rates in Europe, but the long-term side-effect burden in young people \u2014\u202fdriven by the unlicensed use of adult cancer medicines \u2014\u202foften means the price of survival is high, scientists say. Prescribing unlicensed drugs or the \u2018off-label\u2019 use of adult medicines for childhood … Read more<\/a><\/p>\n","protected":false},"author":298,"featured_media":1626,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"generate_page_header":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[12],"tags":[94,217,37],"class_list":["post-1625","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health","tag-cancer","tag-children","tag-health"],"yoast_head":"\nFive things to know about childhood cancer - Horizon Magazine Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/scienceblog.com\/horizon\/1625\/five-things-to-know-about-childhood-cancer\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Five things to know about childhood cancer\" \/>\n<meta property=\"og:description\" content=\"Advances in diagnosis and care have yielded significant improvements in childhood cancer survival rates in Europe, but the long-term side-effect burden in young people \u2014\u202fdriven by the unlicensed use of adult cancer medicines \u2014\u202foften means the price of survival is high, scientists say. 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