Michael Link, MD, professor of pediatrics, Stanford Cancer Institute, 2018 Giant of Cancer Care® in Pediatrics, discusses the evolution of treatment in pediatric oncology.

In recent years, there has been phenomenal progress in the management of pediatric cancers, Link says. Approximately 80% of children with cancer are cured, and in some diseases such as acute lymphoblastic leukemia (ALL), the cure rate is closer to 95%. Looking back, Link says, some types of pediatric cancer were incurable, and only about 40% of patients with ALL were cured. Burkitt’s lymphoma was a difficult-to-treat disease some time ago, but now, physicians are able to cure it with impunity, he adds.

At the 2018 ASCO Annual Meeting, there was an abstract presented that Link thinks has the potential to be practice-changing in pediatric T-cell leukemia. The study showed that adding nelarabine (Arranon), a relatively new drug, to escalating-dose methotrexate was feasible in the already intensive treatment regimen; this therapy also improved patient outcomes compared with the standard of care.

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Michael Link, MD, professor of pediatrics, Stanford Cancer Institute, 2018 Giant of Cancer Care in Pediatrics, discusses the evolution of treatment in pediatric cancer.

Dr. Link on Evolution of Treatment in Pediatric Cancer

Michael Link, MD, professor, Pediatrics, Stanford Cancer Institute, and a 2018 Giant of Cancer Care

 in Pediatric Oncology discusses the current paradigm for treatment in pediatric cancer.

There are several unmet needs in this space, Link says. Brain tumors and central nervous system malignancies are an area where answers are still needed. Patients with metastatic solid tumors are still resistant to therapy and very difficult to cure. Neuroblastoma, a common solid tumor in toddlers, has not seen the needle move far despite very intensive treatment strategies. There is still a long way to go in these settings.

Some of the more exciting recent developments, Link says, are with immunotherapy and chimeric antigen receptor T-cell therapy. The fact that it is possible to manipulate and genetically engineer a patient’s own immune system has resulted in dramatically improved outcomes. This has been particularly effective in recurrent leukemia. A common strategy in pediatric cancer has been to find a successful therapy in relapsed disease and move it to an earlier setting, Link adds.

Michael Link, MD, professor, Pediatrics, Stanford Cancer Institute, and a 2018 Giant of Cancer Care in Pediatric Oncology discusses the current paradigm for treatment in pediatric cancer.

Dr. Link on the Current State of Treatment For Pediatric Cancer

Michael Link, MD, Lydia J. Lee Professor in Pediatric Cancer, professor, Pediatrics, Stanford Cancer Institute, and a 2018 Giant of Cancer Care in Pediatric Oncology, discusses the randomized trial testing nelarabine in patients with T-cell malignancies.

One of the practice changing abstracts presented at the 2018 ASCO Annual Meeting plenary session was the addition of nelarabine to treatment for the management of T-cell leukemia, says Link. T-cell leukemia used to be a disease that was very difficult to treat, and Link says that cure rates plateaued at around 30% to 40%. However, physicians were able to increase those rates with the drugs that were available to them. Link says that these cure rates are now comparable to other pediatric leukemias.

The study showed that adding nelarabine, which is a relatively new drug for the management of leukemia, to escalating-dose methotrexate is a feasible approach in an already intensive treatment regimen. The trial also showed that the addition of nelarabine resulted in a further incremental improvement in outcome. This series of incremental benefit has ultimately characterized the narrative of pediatric oncology, explains Link.

Michael Link, MD

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Dr. Link on Evolution of Treatment in Pediatric Cancer

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