A Pilot Trial Testing the Feasibility of Using Molecular-Guided Therapy in Patients with Recurrent Neuroblastoma — Oak Academic Publishing
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A Pilot Trial Testing the Feasibility of Using Molecular-Guided Therapy in Patients with Recurrent Neuroblastoma
Center for Cancer Genomics and Computational Biology, Pediatric Oncology Translational Research Program at the Van Andel Research Institute in Grand Rapids, Grand Rapids, USA
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Cardinal Glennon Children’s Hospital, Saint Louis University School of Medicine, St. Louis University, St. Louis, USA
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Center for Cancer Genomics and Computational Biology, Pediatric Oncology Translational Research Program at the Van Andel Research Institute in Grand Rapids, Grand Rapids, USA
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Vermont Cancer Center, Department of Medicine, University of Vermont, Burlington, USA
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Vermont Cancer Center, Department of Medicine, University of Vermont, Burlington, USA
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Vermont Cancer Center, Department of Medicine, University of Vermont, Burlington, USA
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Vermont Cancer Center, Department of Medicine, University of Vermont, Burlington, USA
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Rady Children’s Hospital San Diego, University of California San Diego School of Medicine at the University of California San Diego, San Diego, USA
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Department of Pediatric Oncology, Helen DeVos Children’s Hospital, Michigan State University, Grand Rapids, USA
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Center for Children’s Cancer and Blood Disorders, Arnold Palmer Hospital for Children MD Anderson Cancer Center Orlando; Orlando, USA
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Pediatric Hematology/Oncology, Medical University of South Carolina; Charleston, USA
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Pediatric Oncology, Levine Children’s Hospital; Charlotte, USA
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Division of Hematology/Oncology 2J, Connecticut Children’s Medical Center; Hartford, USA
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Department of Pediatric Oncology, Oregon Health Science University; Portland, USA
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Center for Children’s Cancer and Blood Disorders, Arnold Palmer Hospital for Children MD Anderson Cancer Center Orlando; Orlando, USA
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Center for Cancer Genomics and Computational Biology, Pediatric Oncology Translational Research Program at the Van Andel Research Institute in Grand Rapids, Grand Rapids, USA
,
Center for Cancer Genomics and Computational Biology, Pediatric Oncology Translational Research Program at the Van Andel Research Institute in Grand Rapids, Grand Rapids, USA
,
Center for Cancer Genomics and Computational Biology, Pediatric Oncology Translational Research Program at the Van Andel Research Institute in Grand Rapids, Grand Rapids, USA
,
Center for Cancer Genomics and Computational Biology, Pediatric Oncology Translational Research Program at the Van Andel Research Institute in Grand Rapids, Grand Rapids, USA
1 Center for Cancer Genomics and Computational Biology, Pediatric Oncology Translational Research Program at the Van Andel Research Institute in Grand Rapids, Grand Rapids, USA
2 Cardinal Glennon Children’s Hospital, Saint Louis University School of Medicine, St. Louis University, St. Louis, USA
3 Center for Cancer Genomics and Computational Biology, Pediatric Oncology Translational Research Program at the Van Andel Research Institute in Grand Rapids, Grand Rapids, USA
4 Vermont Cancer Center, Department of Medicine, University of Vermont, Burlington, USA
5 Vermont Cancer Center, Department of Medicine, University of Vermont, Burlington, USA
6 Vermont Cancer Center, Department of Medicine, University of Vermont, Burlington, USA
7 Vermont Cancer Center, Department of Medicine, University of Vermont, Burlington, USA
8 Rady Children’s Hospital San Diego, University of California San Diego School of Medicine at the University of California San Diego, San Diego, USA
9 Department of Pediatric Oncology, Helen DeVos Children’s Hospital, Michigan State University, Grand Rapids, USA
10 Center for Children’s Cancer and Blood Disorders, Arnold Palmer Hospital for Children MD Anderson Cancer Center Orlando; Orlando, USA
11 Pediatric Hematology/Oncology, Medical University of South Carolina; Charleston, USA
12 Pediatric Oncology, Levine Children’s Hospital; Charlotte, USA
13 Division of Hematology/Oncology 2J, Connecticut Children’s Medical Center; Hartford, USA
14 Department of Pediatric Oncology, Oregon Health Science University; Portland, USA
15 Center for Children’s Cancer and Blood Disorders, Arnold Palmer Hospital for Children MD Anderson Cancer Center Orlando; Orlando, USA
16 Center for Cancer Genomics and Computational Biology, Pediatric Oncology Translational Research Program at the Van Andel Research Institute in Grand Rapids, Grand Rapids, USA
17 Center for Cancer Genomics and Computational Biology, Pediatric Oncology Translational Research Program at the Van Andel Research Institute in Grand Rapids, Grand Rapids, USA
Background: Neuroblastoma is the most common extracranial solid tumor in children, and treatment options for recurrent neuroblastoma are limited. Using molecular profiling to target the molecular vulnerabilities of neuroblastoma with existing therapeutic agents may result in a rational, data-driven approach with potential to improve clinical outcomes. Methods: The primary objective of this pilot study was to evaluate the feasibility of supporting real-time treatment decisions through predictive modeling of genome-wide mRNA gene expression data from neuroblastoma tumor biopsies. Feasibility was defined as completion of tumor biopsy, histopathological evaluation, RNA extraction and quality control, gene expression profiling within a CLIA-certified laboratory, bioinformatic analysis, generation of a drug predicttion report, molecular tumor board review yielding a formulated treatment plan, and independent medical monitor review within a 2-week period. Results: Five patients with multiply relapsed or refractory neuroblastoma were enrolled between April and June 2010. All biopsies passed histopathology and RNA quality control. Generation of gene expression data and its analysis (3-7 days), reports which linked this data into medically actionable drug candidates (1-5 days), molecular tumor board (1-3 days) and independent medical monitor review (1 day) were all completed in real-time. The average time was 10.5 days for all patients. Conclusion: This study shows that it is feasible to create therapeutic treatment plans based on genomic profiling in less than 12 days. This warrants further testing in a Phase I study to determine safety of predicted treatments and evaluate whether the information obtained in these analyses would result in patient benefit.
KeywordsNeuroblastomaMolecular Guided TherapyPredictive TherapiesMolecular ProfilingGenomic ProfilingPediatric Cancer
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