Think of the Children
Two experts in childhood cancers give their take on the intricacies of pediatric laboratory medicine, how molecular techniques help, and where they think the field will go next
Luke Turner | | Longer Read
Cancer diagnostics and treatment have come a long way over the past 50 years. Before the advent of chemotherapy, surgery – sometimes aided by radiation therapy – was the only effective intervention for cancer patients. Although this approach has long been the primary treatment modality for adults, where the goal is to remove the entire tumor, surgery is not as effective in younger patients. Childhood cancers, even those with apparent similarities, are distinct from those seen in adults – with different developmental stages, tissues of origin, mutations, and gene fusion events.
With the discovery by Sidney Farber that a folate antagonist improved survival in children with acute lymphoblastic leukemia came new hope in the fight against pediatric cancers. The application of chemotherapeutic agents quickly spread across all childhood tumors – and it became clear that children typically respond better to chemotherapy than their adult counterparts. Survival rates for pediatric cancer patients – which until this point had been far inferior to adults – began to rise and even surpassed those for adult cancers.
More recently, the field of immuno-oncology has begun to flourish – but, despite showing promising signs in the adult cancer world, immunotherapy is less effective in pediatric cancers. The efficacy of immunotherapy depends on the strength of the patient’s own immune response – often absent in childhood cancer patients with few tumor mutations. More encouraging is the use of therapies targeting unique gene fusion events. These events are common in pediatric cancers, clearly differentiating their molecular pathogenesis from that of adult disease.
As precision medicine continues to serve patients of all ages, it is clear that our understanding of the genetic drivers behind childhood cancers will be key to future progress and more finely tuned therapeutic interventions. Two initiatives aiming to improve outcomes for childhood cancer patients are the OncoKids Cancer Panel and the Pediatric Cancer Genome Project. We spoke to two of the experts working at the forefront of pediatric laboratory medicine to learn more about the cutting-edge molecular approaches to childhood cancer diagnosis and treatment.
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