Challenging issues in pediatric oncology

Abstract

Improvements in protocol-driven clinical trials and supportive care for children and adolescents with cancer have reduced mortality rates by more than 50% over the past three decades. Overall, the 5-year survival rate for patients with pediatric cancer has increased to approximately 80%. Recognition of the biological heterogeneity within specific subtypes of cancer, the discovery of genetic lesions that drive malignant transformation and cancer progression, and improved understanding of the basis of drug resistance will undoubtedly catalyze further advances in risk-directed treatments and the development of targeted therapies, boosting the cure rates further. Emerging new treatments include novel formulations of existing chemotherapeutic agents, monoclonal antibodies against cancer-associated antigens, and molecular therapies that target genetic lesions and their associated signaling pathways. Recent findings that link pharmacogenomic variations with drug exposure, adverse effects, and efficacy should accelerate efforts to develop personalized therapy for individual patients. Finally, palliative care should be included as an essential part of cancer management to prevent and relieve the suffering and to improve the quality of life of patients and their families.

Figure 1

Survival rates for different cancers among adolescents and young adults. 5-year relative survival rates for selected primary cancers according to year of diagnosis (1975–2006) among children younger than 20 years of age. Data obtained from Surveillance, Epidemiology, and End Results Registries based on follow-up into 2007 of patients from SEER 9 areas (San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, and Atlanta).

Figure 2

Survival rates for different cancers in children. 5-year relative survival rates for children with ALL, AML, HL, NHL, CNS tumor, NB, RB, WT, HB, OS, ES, RMS, GT and MM by age group. Data obtained from Surveillance, Epidemiology, and End Results Registries based on follow up into 2007 of patients from SEER 17 areas (SEER 9 areas plus San Jose-Monterey, Los Angeles, Alaska Native Registry, Rural Georgia, California,—excluding San Francisco, San Jose-Monterey and Los Angeles—Kentucky, Louisiana and New Jersey) who were diagnosed between 1999 and 2006. Abbreviations: ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; CNS, central nervous system; ES, Ewing sarcoma; GT, gonadal germ-cell tumor; HB, hepatoblastoma; HL, Hodgkin lymphoma; MM, malignant melanoma; NB, neuroblastoma and ganglioneuroblastoma; NHL, non-Hodgkin lymphoma; OS, osteosarcoma; RB, retinoblastoma; RMS, rhabdomyosarcoma; WT, Wilms' tumor.