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Treatment for neuroblastoma that has not gone away or has come back

Neuroblastoma that does not go away with treatment is called refractory neuroblastoma. Recurrent (or relapsed) disease is neuroblastoma that comes back after treatment.

It can be more difficult to control recurrent or refractory neuroblastoma. But, there are treatments available. And researchers are looking into how to improve treatment for children living with neuroblastoma that hasn’t gone away, or has come back.

The treatment your child needs depends on a number of factors including:

  • where it has come back
  • the original risk group they were in

Low or intermediate risk group

A child that has a low or intermediate risk disease that has come back where it started might need surgery again with or without chemotherapy.

High risk group

For children with a high risk neuroblastoma, treatment is usually more intense and is likely to include a combination of treatments again. The type of chemotherapy your child will have is likely to be different from their first treatment. And the drugs your child’s specialist recommends depends on a number of factors, including what previous treatments your child had and any side effects they had before.

Or they might suggest targeted radiotherapy. Targeted radiotherapy is similar to the mIBG scan used to diagnose neuroblastoma. As a treatment your child will have a higher dose of radioactive iodine than they did with the scan. The cancer cells pick up the mIBG and die.

As it can be more difficult to treat cancers that come back after the first treatment and your doctor might suggest your child has treatment as part of a clinical trial. This is likely to be trying newer treatments.

Clinical trials

Researchers are looking into different ways of treating relapsed or refractory neuroblastoma.

Monoclonal antibodies

Researchers want to find out if having a drug called bevacizumab can help children with neuroblastoma. Bevacizumab is a type of biological therapy called a monoclonal antibody that targets the tumour’s blood supply

Doctors use bevacizumab to treat a number of adult cancers. It is now being looked at in trials to see if it works in children with relapsed or refractory neuroblastoma. There is a trial  looking at bevacizumumab with different types of chemotherapy. The trial is also looking at which chemotherapy drugs are best to use.

The trial team want to:

  • find out whether having the chemotherapy drugs irinotecan or topotecan as well as temozolomide helps children and young people with neuroblastoma that isn’t responding to other treatment or has come back afterwards
  • see if adding bevacizumab to chemotherapy helps children and young people in this situation
  • learn more about the side effects of the different drug combinations

Chemotherapy

Other researchers are looking at newer chemotherapy drugs to see if they can help children with neuroblastoma that is not responding to treatment or has come back.

Targeted radiotherapy

Researchers are testing drugs called somatostatin analogues. These drugs can target a protein called somatostatin on the surface of many neuroblastoma cells. It is similar to the mIBG treatment that some children with neuroblastoma have.

LuDO is a somatostatin analogue that has a radioactive molecule attached to it. LuDO finds the neuroblastoma cells and then the radioactivity kills them. The clinical trials team are interested in if LuDO can help children and young people with neuroblastoma. And they would like to see how safe it is. 

Anti GD2 T-cell immunotherapy

Anti-GD2 T-cells are made by taking some immune cells (T-cells) from the blood and changing them in the laboratory. Doctors change them by putting a gene into them. You might hear this called CAR T-cell therapy, it is a type of adoptive cell transfer.

T cells are part of the immune system and help fight infections. Doctors hope the new gene will help the T cells to recognise and attack the cancer cells. Results from laboratory studies of anti-GD2 T-cells look promising. This is the first time people have been given these particular cells.

The researchers would like to find out:

  • if they can make anti-GD2 T-cells in the laboratory and if it is safe to give to people
  • about any side effects and the best way to treat them
  • whether giving chemotherapy first, improves how long the anti-GD2 T-cells survive and helps to increase their number
  • how well and for how long the anti-GD2 T-cells survive inside the body
  • whether anti-GD2 T-cells can shrink the neuroblastoma

How to join a clinical trial

The best person to talk to about your child’s treatment, including a joining a clinical trial, is your child’s consultant. 

For information, you can also call the Cancer Research UK nurses on Freephone 0808 800 4040. Lines are open Monday – Friday, 9am to 5pm.
Last reviewed: 
16 May 2018
  • Cancer Research UK Clinical Trials Database

    Accessed January 2018

  • Overview and recent advances in the treatment of neuroblastoma

    SB Whittle and others

    Expert Review of Anticancer Therapy, 2017

    Volume 17, Number 4

  • Cancer in Children: Clinical Management (6th edition)

    MCG Stevens, HN Caron and A Biondi (Editors)

    Oxford University Press, 2012

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