Neuroblastoma Program Head Nai-Kong Cheung discusses a patient with pediatric oncologist Ellen Basu, a specialist in developing innovative immunotherapies for the disease.
We’ve made great strides in the treatment of neuroblastoma, with a range of therapies shown to be effective in slowing or stopping the disease — even when it spreads to the lymph nodes, bones, or bone marrow — and increasing chances of survival.
We believe that with advances in chemotherapy, immunotherapy, and supportive care, there is reason for hope, even for children with high-risk or relapsed cancer — and that our continued efforts will lead to a cure for this disease.
We care for each child with great sensitivity to his or her particular needs and risk for complications from neuroblastoma or its treatment. Each week, the team meets to discuss each child’s progress. We also work closely with oncologists at other locations to ensure that we’re delivering the most effective therapies.
Most children with neuroblastoma will receive one or more of the following treatments.
The initial phase of neuroblastoma treatment, called induction, is designed to reduce the size of the original tumor so that we can safely and effectively remove it through surgery.
Induction usually consists of five rounds of chemotherapy given to your child intravenously (injected through a vein into the bloodstream) on an outpatient basis, which means you won’t need to stay overnight in the hospital.
Most young people with neuroblastoma require surgery to remove the primary tumor. We usually do this after induction therapy has started to ensure that the operation is safe and successful.
However, for some children with neuroblastoma, it’s best to do surgery at the time of diagnosis or later in a cycle of chemotherapy treatment. We always personalize these decisions to your child’s specific situation.
- Radiation Therapy
This treatment, which uses large doses of x-rays to destroy cancer cells, helps to kill neuroblastoma cells that may remain after chemotherapy and surgery. One of the limitations of radiation treatment is that it can damage nearby tissues and result in serious long-term side effects, especially in children.
To minimize damage to healthy tissue, we use a technique originally pioneered at MSK to treat prostate cancer. Called intensity modulated radiation therapy, it precisely targets tumors, sparing healthy tissue even when the tumor is wrapped around a vital organ — as is often the case with neuroblastoma.
Immunotherapy: Antibody 3F8
We use immunotherapy after your child has completed the first three steps above.
A person’s immune system makes proteins called antibodies to attack germs such as bacteria or viruses, but it won’t attack neuroblastoma because the tumor is part of your child’s body. With infusions of an immunotherapy treatment called antibody 3F8, we enable the immune system to detect and destroy neuroblastoma cells that have survived chemotherapy or radiation therapy.
Learn more about how antibody 3F8 works, how we deliver it to your child, and how we can support you in handling common side effects.
Treatment for neuroblastoma generally depends on if your child’s condition is low risk, intermediate risk, or high risk, or if the disease has returned (relapsed) after initial treatment.
Treatment of low-risk neuroblastoma usually only includes surgery or careful observation and follow-up. Sometimes, such as with prenatally diagnosed tumors, we only recommend observation.
In most cases we perform surgery to treat children with intermediate-risk disease, but we personalize our approach based on a close analysis of your child’s risk group and age. Depending on your child’s situation, we may also recommend surgery combined with chemotherapy and radiation, or a variation of these three approaches.
High-risk neuroblastoma is the most difficult type to treat and requires the use of a combination of approaches, beginning with induction therapy, followed by surgery, radiation therapy, immunotherapy, and differentiation therapy. These treatments are delivered in phases, typically over the course of approximately two years.
If your child comes to us after starting treatment elsewhere, our team will review his or her case and propose a treatment plan, with your input.
Once we understand the extent and risk level of your child’s neuroblastoma, we’ll formulate a specific treatment plan that may include the following approaches.
If your child has relapsed or refractory neuroblastoma — which means the cancer either returned after initial treatment or didn’t respond to treatment — we can offer a number of innovative treatment strategies. We’ve been at the forefront of efforts to develop treatments that prolong survival but don’t cause debilitating long-term side effects. In particular, our program focuses on immunotherapies, including newer versions of antibody therapy and vaccines.
As a first step, we’ll review your child’s treatment history together as a team, and then generate a personalized treatment plan.
We’re the only team worldwide with a treatment program for neuroblastoma that has spread to the brain.
If your child’s neuroblastoma has relapsed in his or her brain or central nervous system, we may be able to offer a treatment pioneered at MSK using a radioactive antibody. With this treatment, we are now able to cure 70 percent of children with this condition.
We’re committed to caring for your child even after treatment has ended. We create a follow-up medical care program customized to each child’s needs that will help him or her have the best quality of life possible.
For patients who began their treatment at MSK and achieved complete remission, we’ve found that the time in which a relapse could occur is most often within three years of diagnosis. However, relapses can occur up to five years after diagnosis. Unfortunately, there is no time period after which we can say for certain that a patient will not relapse.
Nevertheless, by three years after diagnosis, our concern for your child’s health shifts from relapse to the long-term effects of cancer treatment. At this point, we’ll likely recommend that your child transition to the care of the experts in our Long-Term Follow-Up Program. This team of doctors, nurse practitioners, social workers, and others screen for, monitor, treat, and coordinate care for medical issues that may arise as a result of neuroblastoma treatment.