The study is a beautiful demonstration of the utility of correlative biology studies that allow for the identification of genetic and molecular features of tumors, which can help us identify cohorts of patients who may not do well with standard therapy and who may benefit from intensification of treatment.
—Alison M. Friedmann, MD
Commenting on the AREN0532/AREN0533 data, Alison M. Friedmann, MD, of the Department of Hematology/Oncology at Massachusetts General Hospital, Boston, said that this is an important study.
“This continues to build on the highly successful risk-adapted treatment approach of the previous National Wilms Tumor Study Group [NWTS] trials. Previous trials were limited to the use of tumor stage and histology [presence or absence and degree of anaplasia] to stratify patients, but careful biology studies conducted on patients enrolled in NWTS-5 identified a small subset of patients with a genetic feature in their tumor cells that had a significant adverse impact on event-free survival,” she explained.
The present study, conducted by the Children’s Oncology Group, tested for this abnormality prospectively in tumor tissue obtained at the time of diagnosis, identifying it in 7.7% of the patients enrolled (87 of the total 1,134).
“Intensifying therapy for this handful of patients improved their event-free survival, though it is anticipated that the additional therapy will introduce a risk of reproductive dysfunction for the advanced-stage patients that they would otherwise not have had, which is more likely to be an issue for male survivors than females,” Dr. Friedmann continued.
“The study is a beautiful demonstration of the utility of correlative biology studies that allow for the identification of genetic and molecular features of tumors, which can help us identify cohorts of patients who may not do well with standard therapy and who may benefit from intensification of treatment. This type of research is important even in diseases like Wilms tumor, which have an excellent prognosis overall, and the findings provide a strong rationale for the planned national effort—Project: Every Child—which will procure tumor samples for a huge biorepository linked to clinical data, allowing us to continue to improve the outcomes in childhood cancer,” she concluded. ■
Disclosure: Dr. Friedmann reported no potential conflicts of interest.
Data from two phase III studies led by the Children’s Oncology Group show that augmenting or intensifying therapy for children with high-risk Wilms tumor improved relapse-free survival. These children are deemed to be at high risk due to a specific chromosomal abnormality that confers worse...