New metronomic approach to neuroblastoma

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Published: 10 Jul 2014
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Prof Frank Berthold - University Hospital Köln, Köln, Germany

Prof Berthold talks to ecancertv at the Metronomic Chemotherapy Meeting in Milan about the use of metronomic therapy in treating children with neuroblastoma.

I was part of the metronomic conference in Marseilles and at that time we sat together and thought there must be another way in treating our patients. So we made some progress over the last three decades but the progress is still unsatisfactory so our patients suffer a lot, not only from the tumour but also from the therapy. So the progress is there but it’s unsatisfactory and so a metronomic approach appears very attractive because it does not destroy… it considers the environment and considers also the immune response and the interaction between the compartments have been underestimated in the past.

What was the standard treatment for neuroblastoma?

Neuroblastoma is quite a challenging tumour because we have at least two, maybe even more, types. One type is spontaneous regressing tumour which accounts for approximately half of the patients and the other part, this is a highly aggressive tumour, in most cases metastatic already at diagnosis and these kids, they are small kids, get everything that is on the market. So there has been high dose chemotherapy, myeloablative therapy, several operations, radiotherapy and continuous maintenance therapy with retinoic acid and, in recent time, also with immunotherapy. It’s a heavy burden for the kids and so we started now with the metronomic approach, which takes quite a time for administrative reasons, but now we have the first pilot patients and they look quite… or the course of the disease in those patients looks quite promising. I cannot tell too much because we’re starting with the trial in the next two or three months but we are quite optimistic that we have another… the philosophy of treatment will change with that.

What is the percentage of overall survival in patients treated in the classic way?

The survival for the high risk patients is approximately 30-40% long term survival, so more than five years. For the good news neuroblastoma is almost 100% but not all of them survive because it’s also a dangerous tumour. But if you treat them in the right way or just observe then the percentage is quite high and the quality of life for them is quite good.

In the aggressive type there are still 60% which cannot be treated?

Yes, those die and they have some good times during the treatment but one has to consider that the treatment itself is a very heavy, difficult time for them.

Which drugs are you using in the metronomic context?

This trial we are planning to do uses cyclophosphamide daily for a year, celecoxib daily for a year, etoposide for four cycles of 21 days and vinblastine, that’s also an anti-angiogenic drug, every fourteen days IV.

Is this a national trial?

It starts as a national trial but we hope that we have very soon, if it works, that it can be distributed to other countries. There is quite a high interest in it.

What do you think of the Metronomic Global Health Initiative?

It’s a very interesting initiative and I heard for the first time here so I think one should go along this way. We need support for that and good idea.

What do you think the future holds for metronomic therapy?

I cannot say what I think, I can say I hope it will change the philosophy of anti-cancer therapy, at least in children.