2. The Burden of cancer
Indian Population : 1.27 bn / 127 cr (18% of world)
30% of population is 0-14 yrs: 381 mn /38 cr
Overall incidence of childhood cancer is 38-124 per mn / yr
15,000- 50,000 new cases per year ( worldwide 160,000 new
cases ) .
Approx. 100 new cases every day in India
5. Types of childhood cancer
Cancer Percentage
Acute Leukemias 28%
CNS tumors 21%
Lymphomas 11%
Neuroblastomas 7.5%
Soft Tissue Sarcomas 7.4%
Wilm`s Tumor 6%
OS and Ewing`s
Sarcoma
5%
Retinoblastoma 3%
Other rare tumors 12.5%
“More”
Common
Common
“Less”
Common
6. Is Childhood cancer curable ?
Is it worth employing resources
for children suffering from cancer ?
7.
8. Childhood Cancer Therapy
1950s – Universally Fatal diagnosis
1960s – HL, WT, sarcomas –treated with Sx
/RT
1970s – “Multiagent chemotherapy era ”
1980s – Risk-directed Therapy
1990s – Further Refining Therapy (Genetic
Advances)
21 Century - ?
11. Newer Advances
Improvement in Diagnostics = Correct diagnosis
Risk Categorization = personalized therapy
Minimal residual disease = Monitoring of
effectiveness of treatment
Reinventing /inventing New treatment strategies
Availability of Targeted therapy
Changing concepts in Transplantation
12.
13. Journey from FAB to Immunophenotype
to Molecular Classification
FAB Classification
L1
L2
L3 (Burkitt`s)
14. OAS EFS Relapse rate
T cell
Precusor
T cell
Minimal Residual Disease
neg
POS
T cell ALL with
atypical
immunophenotype
Improvements In Diagnostics
= correct diagnosis
Elaine et al, 2000s
Cannot be cured without transplant
15.
16. Doing genetic studies is important
Lancet 2008; 371: 1030–43
BCR-ABL,
MLL
TEL-AML1,
Hyperdiploid>50
T-ALL E2A-PBX1
Generally good-risk,
lower intensity
Generally high-risk,
higher intensity
Infant leukemia
Adolescent leukemia
17. Need of Genomic Classification
Present risk categorization is not fool proof
Identification of the group of genes responsible of
outcome
These microarray chips identifies expression of large
number of genes ranging from few hundred to few
thousand
23. Impact of doing PET in HL
Gallamini A, Hutchings M, Rigacci L, et al.: JCO 2007, accepted.
After 2 ABVD
Gallamini A, Hutchings M, Rigacci L, et al.: JCO 2007
24. *a) large mediastinal mass; b) extranodal disease; c) high ERS; d) 3 or more areas*a) large mediastinal mass; b) extranodal disease; c) high ERS; d) 3 or more areas
Impact of doing PET in HL
HD 16 trial design of German HL group
Strategy to reduce treatment to prevent late
side effects
29. Changing concepts
Philadelphia Positive patients can be treated without
going for transplantation
Only 30% have identical sibling donor, rest may opt for
MUD , associated with high risk of GVHD
NK cell , KIR mismatch transplants could be the answer
for these patients
30. Future Strategies
1. Response adapted intensity (clinomics)
-MRD/ PET: as predictor of early response and
prognosticator
2. Risk adapted strategy (genomics)
- using gene-expression profiles for risk groups
3. Targeted/ molecule- directed therapy
(proteomics)
4. Global Cooperative Trials (globolics)
31. India U.S.A.
New cases / yr 50,000 12,400
Rx, curative intent <30% 100%
Cure rate, adequ. Rxed <50% 80%
Overall cure rate 20% 70%
Rxed on Co-op Groups 1% 98%
Pediatric oncology facts
Courtesy : Dr. Advani 2000
32. Take home message
1. Childhood cancer is curable
2. It’s the fundamental right of the child to have access
to treatment in v/o improved possibility of survival
3. It is cost effective given the large number of potential
years saved
