According to Nai-Kong Cheung, Head of the Neuroblastoma Program at Memorial Sloan-Kettering, Emily's multimodality treatment was typical up until the point that the brain metastasis was found. Cases that involve what is referred to as central nervous system (CNS) relapse occur in a subset of neuroblastoma patients. Unfortunately, these relapses can prove difficult to cure because the type of radiation that is normally used to treat the disease is less effective against tumors in the CNS. However, doctors at Memorial Sloan-Kettering have recently begun to treat patients with CNS relapse using monoclonal antibodies (either 3F8 or 8H9) to deliver liquid radiation directly to neuroblastoma cells in the CNS.
Emily was the first female patient to receive 8H9 monoclonal therapy. Conceived and developed in Memorial Sloan-Kettering's neuroblastoma laboratory, the 8H9 antibody has been very effective in fighting brain metastases. Currently, 14 neuroblastoma patients with brain metastasis have been treated with the 8H9 protocol, the majority of whom are in CNS remission, meaning there is no sign of cancer in the brain. Emily, fortunately, can be counted among this group.
When asked about Emily and her struggle with neuroblastoma, Dr. Cheung reflects on the evolution of treatment for the disease. "I made a promise with myself 25 years ago to deal with this tumor, hoping that someday there will be survivors," he says. "We have a dream team here at Memorial Sloan-Kettering. As a result of this institution's efforts, we have come quite far, with many children surviving the disease."
Dr. Cheung recalls that in the early days doctors were so focused on saving the lives of children with more treatable forms of neuroblastoma that the problem of brain metastasis was under the radar. "It was like a mountain behind the mountain," Dr. Cheung explains. "I worry there may be future surprises that will need to be overcome, but it does look like calmer waters ahead. Emily, like others, is a trailblazer, leading the pack and making history."
