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  • Review Article
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Challenging issues in pediatric oncology

Nature Reviews Clinical Oncology volume 8, pages 540–549 (2011)Cite this article

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Abstract

Improvements in protocol-driven clinical trials and supportive care for children and adolescents with cancer have reduced mortality rates by more than 50% over the past three decades. Overall, the 5-year survival rate for patients with pediatric cancer has increased to approximately 80%. Recognition of the biological heterogeneity within specific subtypes of cancer, the discovery of genetic lesions that drive malignant transformation and cancer progression, and improved understanding of the basis of drug resistance will undoubtedly catalyze further advances in risk-directed treatments and the development of targeted therapies, boosting the cure rates further. Emerging new treatments include novel formulations of existing chemotherapeutic agents, monoclonal antibodies against cancer-associated antigens, and molecular therapies that target genetic lesions and their associated signaling pathways. Recent findings that link pharmacogenomic variations with drug exposure, adverse effects, and efficacy should accelerate efforts to develop personalized therapy for individual patients. Finally, palliative care should be included as an essential part of cancer management to prevent and relieve the suffering and to improve the quality of life of patients and their families.

Key Points

  • Prophylactic cranial irradiation can be omitted from the treatment of patients with acute lymphoblastic or myeloid leukemia, with the use of effective systemic and intrathecal therapy

  • Vigilant supportive care can reduce morbidity and mortality, and improve event-free survival of acute myeloid leukemia

  • The next generation of treatment for brain tumors will be tailored to specific molecular subtypes of disease to improve the cure rates and reduce the long-term sequela of therapy

  • The cure rates have improved dramatically over the past three decades for patients with localized solid tumors and hematologic cancers

  • Patients with disseminated disease continue to fare poorly and some are now receiving targeted therapies against specific molecular alterations

  • Integration of palliative care into the ongoing care of children with cancer improves the quality of pediatric oncology care

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Figure 1: Survival rates for different cancers among adolescents and young adults.
Figure 2: Survival rates for different cancers in children.

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Acknowledgements

This project was supported in part by grant CA21765 and GM092666 from the National Institutes of Health, and by the American Lebanese Syrian Associated charities. C. P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape, LLC-accredited continuing medical education activity associated with this article.

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  1. St. Jude Children's Research Hospital and the University of Tennessee Health Science Center, 262 Danny Thomas Place, Memphis, 38105, TN, USA

    Ching-Hon Pui, Amar J. Gajjar, Javier R. Kane, Ibrahim A. Qaddoumi & Alberto S. Pappo

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  1. Ching-Hon Pui
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  2. Amar J. Gajjar
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  3. Javier R. Kane
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All authors were involved in the research of data, discussion of content, writing the Review and revising the manuscript before submission.

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Correspondence to Ching-Hon Pui.

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Pui, CH., Gajjar, A., Kane, J. et al. Challenging issues in pediatric oncology. Nat Rev Clin Oncol 8, 540–549 (2011). https://doi.org/10.1038/nrclinonc.2011.95

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