High Risk Neuroblastoma in the new decade: Incorporating targeted therapies to maximize impact in current Children’s Oncology Group trials (C226)

12:15 – 1:15 pm Friday, September 4

coglogoWhile the overall cure rate for childhood cancer is approaching 80%, the prognosis for long-term survival for children with high risk neuroblastoma lags considerably behind, at 50%–60%. Upfront standard treatment for high-risk neuroblastoma protocols within the Children’s Oncology Group (COG) has historically utilized all available modalities of cancer treatment including chemotherapy, surgery, myeloablative chemotherapy with stem cell rescue, radiation therapy, differentiating agents, and most recently biologic therapy with anti-GD2 antibody (dinutuximab) used post consolidation in ANBL0032.

131I-MIBG therapy, shown to be effective in the relapse setting, has been piloted by the COG in ANBL09P1 as an adjunct to up-front induction chemotherapy and shown to be feasible. Likewise, dinutuximab has been shown to be effective in the relapse setting when combined with chemotherapy in ANBL1221. Crizotinib, an ALK inhibitor, has been evaluated in ADVL0912 and ADVL1212 and in combination with chemotherapy in ANHL12P1. Three contemporary COG studies for high-risk neuroblastoma are evaluating the addition of these therapies. ANBL1531, in a randomization, studies the inclusion of 131I-MIBG therapy in upfront induction and includes an additional arm that incorporates crizotinib for patients with ALK mutated tumors into first line therapy. Additionally, this study has dropped the use of interleukin-2 in post consolidation due to emerging data about its contribution to response. ANBL17P1 incorporates dinutuximab into induction chemotherapy cycles. ANBL1821 includes the addition of eflornithine (DFMO) to relapse therapy. These additions to upfront therapy create complex regimens for nurses to navigate. This session will review the current COG trials incorporating these targeted therapies and review the pharmacology and nursing considerations for dinutuximab, 131I-MIBG, ALK inhibitors, and eflornithine.


Wendy Fitzgerald, MSN APRN PPCNP-BC

Denise Mills, MN RN(EC) NP CPHON®

CNE Hours: