Kelly Bailey, MD, PhD, physician, department of Pediatric Hematology/Oncology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, discusses the treatment of pediatric patients with sarcoma.

Bailey says that while physicians have their go-to cytotoxic therapy for the treatment of osteosarcoma or Ewing sarcoma at relapse, there are many exciting agents in development. For example, there is an LSD-1 inhibitor in development, as well as inhibitors trying to target the EWS/FLI-1 fusion protein in Ewing sarcoma. There are a lot of exciting agents out there, Bailey says, but without biopsy information, the optimal use of these agents is unknown.

A tissue biopsy is recommended when a patient relapses, Bailey says. Although, the concept of liquid biopsies and circulating tumor DNA (ctDNA) may be a way to detect relapse or persistent disease at a low level when there is no radiographic evidence. Also, observing the circulating tumors cells and ctDNA are a way to monitor how tumors change over time, Bailey adds.

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Kelly Bailey, MD, PhD, physician, department of Pediatric Hematology/Oncology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, discusses the treatment of pediatric patients with sarcoma.
 

Dr. Bailey Discusses the Treatment of Pediatric Patients With Sarcoma

Kelly Bailey, MD, PhD, physician, department of Pediatric Hematology/Oncology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, discusses clinical needs in pediatric patients with bone sarcoma.

There are 3 clinical needs for pediatric patients with bone sarcoma, says Bailey. Physicians need to prevent metastases from occurring, better detect micrometastatic disease before it is visible on PET scans or CT scans, and better treat metastases once they occur.

Progress has been limited in the past 3 decades in pediatric patients with metastatic disease, says Bailey. Therefore, when relapse occurs, they need to be sampled and biopsied because metastatic tumors are not like original tumors. If patients consent, these samples can also be given to the Children’s Oncology Group for further testing.

Although progress has been limited, Bailey states that there are therapeutic opportunities that physicians could explore if they understood what signaling pathways are apparent in those metastatic lesions.

Dr. Bailey on Clinical Needs in Pediatric Patients With Bone Sarcoma

Kelly Bailey, MD, PhD, physician, department of Pediatric Hematology/Oncology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, discusses key molecular pathways in pediatric bone sarcoma.

A key molecular pathway in both osteosarcoma and Ewing sarcoma is the Wnt pathway. Both of these tumor types have been shown to be more aggressive when those cells secrete Wnt, Bailey says. Wnt is a potentially therapeutically targetable pathway, and there have been recent studies looking at porcupine inhibitors that target Wnt. Bailey says that these studies are investigating whether blocking Wnt signaling or the downstream effects of Wnt signaling can affect how these sarcomas metastasize.

Additionally, IL-8 is an important molecular pathway in osteosarcoma, and in Ewing sarcoma, EWS-FLI-1 has been identified as a key molecular pathway, Bailey concludes.

Kelly Bailey, MD, PhD, physician, department of Pediatric Hematology/Oncology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, discusses key molecular pathways in pediatric bone sarcoma.
 

Kelly Bailey, MD, PhD

Articles

Dr. Bailey Discusses the Treatment of Pediatric Patients With Sarcoma

Dr. Bailey on Clinical Needs in Pediatric Patients With Bone Sarcoma

Dr. Bailey Discusses Key Molecular Pathways in Bone Sarcoma