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

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.