Pediatric Cancer Survivorship during COVID

Transcript

00:00 --> 00:02Support for Yale Cancer Answers
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00:14 --> 00:15Welcome to Yale Cancer
00:15 --> 00:17Answers with your host doctor
00:17 --> 00:20Anees Chagpar. Yale Cancer Answers
00:20 --> 00:22features the latest information on
00:22 --> 00:24cancer care by welcoming oncologists and
00:24 --> 00:26specialists who are on the forefront of
00:26 --> 00:29the battle to fight cancer. This week,
00:29 --> 00:31it's a conversation about pediatric cancer
00:31 --> 00:33survivorship with Doctor Nina Kadan-Lottick.
00:33 --> 00:34Dr. Kadan-Lottick is
00:34 --> 00:37the medical director of the HEROS
00:37 --> 00:39Program and an associate professor
00:39 --> 00:41of Pediatrics and hematology oncology
00:41 --> 00:43at the Yale School of Medicine
00:43 --> 00:45where doctor Chagpar is a
00:45 --> 00:46professor of surgical oncology.
00:47 --> 00:50Nina, maybe we can start off by
00:50 --> 00:53you laying some of the groundwork.
00:53 --> 00:55When we think about
00:55 --> 00:56pediatric cancers or cancers
00:56 --> 00:58occurring in children uniformly,
00:58 --> 01:00the first emotion
01:00 --> 01:02that strikes is heartbreak.
01:02 --> 01:04But tell us a little bit more
01:04 --> 01:07about how many kids every year
01:07 --> 01:10get cancer and the different kinds
01:10 --> 01:12of cancers that they get.
01:12 --> 01:15So there are about 10,000 kids in the
01:15 --> 01:19country that get diagnosed with cancer and
01:19 --> 01:22the great news is that the vast majority
01:22 --> 01:26will be long term survivors, cured for good.
01:26 --> 01:29So we have cure rates among all
01:29 --> 01:32comers of about 85% and about 1/3 of
01:32 --> 01:34the cancers are leukemia/lymphomas.
01:34 --> 01:37Another 25% are brain tumors
01:37 --> 01:40and then the rest are of a wide
01:40 --> 01:42variety of different cancers.
01:42 --> 01:45But the good news is for most cancers we
01:45 --> 01:49have some very effective therapies and
01:49 --> 01:52some really exciting ones coming down the pipe.
01:54 --> 01:57I can only imagine
01:57 --> 02:00what it must be like to hear
02:00 --> 02:03the words your child has cancer
02:03 --> 02:05but let's take a step abck
02:05 --> 02:07even back from that.
02:07 --> 02:10How is it that these cancers are
02:10 --> 02:12diagnosed because you know most
02:12 --> 02:15parents are not anticipating that
02:15 --> 02:18their child is going to get cancer.
02:18 --> 02:20This isn't something that we
02:20 --> 02:23get screening tests for.
02:23 --> 02:26So how do we look at that and
02:26 --> 02:29how is it that
02:29 --> 02:32cancer is diagnosed?
02:32 --> 02:35It is very, very rare and so I would
02:35 --> 02:38not want most families to
02:38 --> 02:42worry about this as something that
02:42 --> 02:45they have to actively look for.
02:45 --> 02:49It really does present in ways that
02:49 --> 02:52show that the child has something
02:52 --> 02:56going on that's very different from
02:56 --> 02:59what would be expected.
03:01 --> 03:05What can commonly happen are fevers that last longer than five days.
03:05 --> 03:06Significant weight loss
03:06 --> 03:09that's more than 10% of the child's
03:09 --> 03:12weight or not growing, having night
03:12 --> 03:14sweats or being having drenching
03:14 --> 03:18sweaty clothes in the middle the night,
03:18 --> 03:21not just feeling warm with a little
03:21 --> 03:24perspiration, and having
03:24 --> 03:26lumps and bumps that grow.
03:26 --> 03:29It's really normal for kids
03:29 --> 03:32to have lymph nodes that you can feel,
03:32 --> 03:35but they tend to kind of go up and down.
03:35 --> 03:38They don't just keep on getting bigger,
03:38 --> 03:40so these are things that are very unusual
03:40 --> 03:43and would stand out to a pediatrician or
03:43 --> 03:46two a parent as just not being right,
03:46 --> 03:48and that's what usually gets medical
03:48 --> 03:50attention that leads to the tests
03:50 --> 03:50that make
03:50 --> 03:52the diagnosis.
03:52 --> 03:55I guess one thing is
03:55 --> 03:57that while these are very rare,
03:57 --> 04:00when something just doesn't seem right with
04:00 --> 04:03your child over a prolonged period of time,
04:03 --> 04:06you really ought to get it checked out,
04:07 --> 04:10and so when you present your
04:10 --> 04:12pediatrician with your child who
04:12 --> 04:14may have some of these symptoms,
04:14 --> 04:17how is that generally worked up?
04:17 --> 04:19One would imagine that pediatricians
04:19 --> 04:21too are thinking common things.
04:21 --> 04:25Is this a flu?
04:25 --> 04:26Is this a cold?
04:26 --> 04:28How is it that
04:28 --> 04:31things are worked up where pediatricians
04:31 --> 04:35clue into the fact that this is unusual.
04:35 --> 04:38And what further work up is needed.
04:39 --> 04:42I will say pediatricians are brilliant
04:42 --> 04:44because they see thousands of children.
04:44 --> 04:48They have a gut feeling when something
04:48 --> 04:52doesn't feel right and I totally
04:54 --> 04:57agree with you that if a
04:57 --> 04:58parent feels like something's not
04:58 --> 05:01right to go to the pediatrician
05:01 --> 05:03and have that evaluated and so
05:03 --> 05:06some of these are the questions that I
05:06 --> 05:08just mentioned to you that are asked,
05:08 --> 05:11and if any of those are positive
05:11 --> 05:13with any of those things going on,
05:13 --> 05:15that would be a red flag,
05:15 --> 05:17and then the pediatrician does
05:17 --> 05:19a really close exam and checks
05:19 --> 05:22for the size of lymph nodes in
05:22 --> 05:24the neck and under the arms and
05:24 --> 05:27listens to the lungs and feels the
05:27 --> 05:30belly very carefully for organ
05:30 --> 05:33enlargement or any masses and also
05:33 --> 05:36feels any other body parts that
05:36 --> 05:38are affected so if anything doesn't
05:38 --> 05:42feel right, it feels firmer
05:42 --> 05:45or larger or doesn't move,
05:45 --> 05:48that would be a red flag and then
05:48 --> 05:51we get a phone call in pediatric
05:51 --> 05:53oncology and we are available 24/7
05:53 --> 05:56to our community pediatricians and we
05:56 --> 05:59just talk it over and sometimes we
05:59 --> 06:02have some other signs or hints that
06:02 --> 06:04help us know it's something that's
06:04 --> 06:07really benign and not worrisome that
06:07 --> 06:10it sounds more like mono or we'll
06:10 --> 06:12use our experience to figure out
06:15 --> 06:17what is something less worrisome or something
06:17 --> 06:19characteristic of an unusual
06:19 --> 06:22manifestation of a common infection,
06:22 --> 06:25or whether it indicates that there could
06:25 --> 06:28be something totally different going on,
06:28 --> 06:31like arthritis or another joint problem.
06:31 --> 06:34But if it's worrisome to us,
06:34 --> 06:38then what we do is we bring
06:38 --> 06:41the child in right away.
06:41 --> 06:43If the clinic is not open,
06:43 --> 06:46it can even be through the emergency
06:46 --> 06:49room and we start by getting blood
06:49 --> 06:52tests that indicate if the parts of
06:52 --> 06:54the blood are being made properly,
06:54 --> 06:56which can indicate leukemia,
06:56 --> 06:59lymphoma which indicate whether there are
06:59 --> 07:02chemicals that can be created by the tumor.
07:03 --> 07:05When cells are rapidly dividing,
07:05 --> 07:08they can create more potassium
07:08 --> 07:09and uric acid.
07:09 --> 07:11We do X Rays to look for masses
07:11 --> 07:14and in the in clinic we
07:14 --> 07:16can rapidly get CTS or ultrasounds
07:16 --> 07:19done within hours and then
07:19 --> 07:21our goal is to make the right
07:21 --> 07:23diagnosis and determination as soon
07:23 --> 07:25as possible and for social reasons,
07:25 --> 07:26unlike adults,
07:26 --> 07:28we often even admit patients not
07:28 --> 07:30necessarily because they're so sick
07:30 --> 07:32that they have to be admitted,
07:32 --> 07:34but just to make the work up happen
07:34 --> 07:36faster so that everyone
07:36 --> 07:39can get the answer right away and
07:39 --> 07:41we can start working on a plan
07:41 --> 07:43that will make the child better.
07:43 --> 07:44And as I said,
07:44 --> 07:47I really feel like my field is a
07:47 --> 07:49field of hope and optimistic
07:49 --> 07:51positivity because the
07:51 --> 07:53vast majority of the time we have
07:53 --> 07:56something really great that we can
07:56 --> 07:58offer where we expect it to work,
07:58 --> 08:00and we expect the child to come
08:00 --> 08:03through at the other end and
08:03 --> 08:04be a long term survivor.
08:04 --> 08:07Yeah, that's so great to hear because
08:07 --> 08:09I think that much of the general
08:09 --> 08:12public when they hear the word cancer
08:12 --> 08:15it doesn't really strike a chord of hope,
08:15 --> 08:18and when you think about cancer in kids,
08:18 --> 08:20many people experience more heartbreak.
08:20 --> 08:23But we're going to talk about all of
08:23 --> 08:25the treatments and the optimism that
08:25 --> 08:28is entailed with that in a second,
08:28 --> 08:29but before we get there,
08:29 --> 08:32so you have a child who comes in,
08:32 --> 08:34who was seen by their
08:34 --> 08:35pediatrician,
08:35 --> 08:38and it was felt that things just
08:38 --> 08:41weren't right and they got some
08:41 --> 08:44blood work and some scans and so on.
08:44 --> 08:46In the adult population,
08:46 --> 08:49usually the next step is a biopsy
08:49 --> 08:53to try to make a definitive diagnosis,
08:53 --> 08:55is it the same
08:55 --> 09:00way in kids?
09:00 --> 09:02The most common childhood cancers
09:02 --> 09:03are leukemia lymphomas,
09:03 --> 09:06so the best place to do a biopsy is
09:06 --> 09:09in the bone marrow, which is inside
09:09 --> 09:12the bones where we make our blood
09:12 --> 09:14and the most accessible site is the
09:14 --> 09:17back of the hip because it's close to
09:17 --> 09:20the surface of the skin and that's
09:20 --> 09:22an outpatient procedure that we can
09:22 --> 09:24do with sedation
09:27 --> 09:29and we can take a sample,
09:29 --> 09:31look at it under microscope.
09:31 --> 09:34If it is a tumor of the brain
09:34 --> 09:36or in another body part,
09:36 --> 09:37then a biopsy is done,
09:37 --> 09:40and that's a very important part.
09:40 --> 09:42We first do those scans and
09:42 --> 09:44blood tests to say is
09:44 --> 09:46it worth doing more.
09:46 --> 09:48But if we are worried then
09:51 --> 09:53that will actually make the
09:53 --> 09:55diagnosis with the biopsy and
09:55 --> 09:57then the really exciting part
09:57 --> 10:00about being an oncologist in 2021
10:00 --> 10:04is that it's not just what the biopsy
10:04 --> 10:08shows in terms of what the cancer type is.
10:08 --> 10:10We also further analyze it for
10:10 --> 10:12the genetics of the tumor,
10:12 --> 10:16not the genetics that the child is born with,
10:16 --> 10:18but in the tumor cells,
10:18 --> 10:20because that can inform us
10:20 --> 10:23what is the best therapy to achieve
10:23 --> 10:26cure and sometimes it also tells
10:26 --> 10:29us that we can use a certain drug
10:29 --> 10:31that targets exactly what that
10:31 --> 10:34tumor cell is doing wrong.
10:34 --> 10:37And what allows it to divide,
10:37 --> 10:39and it can be what we call
10:39 --> 10:41a directed or smart
10:41 --> 10:43therapy.
10:43 --> 10:45This whole concept of personalized medicine,
10:45 --> 10:47figuring out what genes are turned
10:47 --> 10:50on and turned off in a particular
10:50 --> 10:53cancer and allowing us to pick
10:53 --> 10:55targeted therapies is something that
10:55 --> 10:58we've talked a lot about on this show,
10:58 --> 11:00predominantly in adult cancers.
11:00 --> 11:02But it's great to hear that that
11:02 --> 11:05occurs in pediatric cancers as well.
11:05 --> 11:07And again I want to spend the second
11:07 --> 11:10half of the show really talking about
11:10 --> 11:13the personalized therapies and all
11:13 --> 11:15of the optimism that goes into that.
11:15 --> 11:18But before we get there,
11:18 --> 11:20one of the questions that I think
11:20 --> 11:23many parents who may have a child
11:23 --> 11:25with cancer may be asking is why me,
11:25 --> 11:28why my child, what predisposed to this?
11:28 --> 11:30It's not like lung cancer,
11:30 --> 11:32where you can say this child was
11:32 --> 11:35smoking for X number of years, or
11:35 --> 11:38that there may
11:38 --> 11:41be a factor of obesity necessarily.
11:41 --> 11:44So tell us a little bit more about
11:44 --> 11:47the predisposing factors,
11:47 --> 11:49what causes these childhood cancers?
11:49 --> 11:52Well, the simple answer is for
11:52 --> 11:55most of them, we don't know,
11:55 --> 11:59and only about 5 or 6% of them are
11:59 --> 12:01due to familial cancer syndromes.
12:01 --> 12:03This can be because the child
12:03 --> 12:06is born with a genetic
12:08 --> 12:11condition like for example Down syndrome
12:11 --> 12:14is a condition associated with increased risk
12:14 --> 12:17of leukemia
12:17 --> 12:23or there can be
12:23 --> 12:25other syndromes
12:25 --> 12:28that have been identified in adults,
12:28 --> 12:30but that's only accounting for a few
12:30 --> 12:33and in terms of environmental exposures,
12:33 --> 12:35we've looked really hard
12:35 --> 12:38and there's been question
12:38 --> 12:40about everything from cell phone use
12:40 --> 12:44to living near power lines
12:44 --> 12:47to what a mom ate during pregnancy
12:47 --> 12:51and we have not really found
12:51 --> 12:53any strong associations.
12:53 --> 12:56Certainly very horrible tragedies like
12:56 --> 13:00nuclear accidents have been associated with
13:00 --> 13:03an increased risk of cancer in children.
13:03 --> 13:05And for that reason we really try to
13:05 --> 13:08limit the radiation we give and the
13:08 --> 13:10diagnostic tests to what's necessary,
13:10 --> 13:12but they're not really at the
13:12 --> 13:15doses we do in everyday life or
13:15 --> 13:17live within everyday life.
13:17 --> 13:19They're not associated,
13:19 --> 13:21so we don't know.
13:21 --> 13:24That is an answer to be decided,
13:24 --> 13:26and I think one of the interesting
13:26 --> 13:28things is that we're
13:28 --> 13:31we've starting to appreciate there may
13:31 --> 13:33be an association with environmental
13:33 --> 13:35factors that play a role that combine
13:35 --> 13:38maybe in a multi step way.
13:38 --> 13:40So maybe a child inherits the ability to be
13:40 --> 13:43more sensitive to an environmental exposure,
13:43 --> 13:45so it's not as simple an
13:45 --> 13:47association like smoking a lot,
13:47 --> 13:50and then maybe some of those
13:50 --> 13:51environmental exposures could
13:51 --> 13:52be something like getting a
13:52 --> 13:54certain type of infection that's
13:54 --> 13:56a common childhood infection.
13:56 --> 13:57But one child may be
14:01 --> 14:04more sensitive to that and we get hints of that.
14:04 --> 14:07For example, a certain kind of lymphoma,
14:07 --> 14:10Burkitt's is more common in Africa
14:10 --> 14:12in areas where EBV or what
14:12 --> 14:14causes mono is more common,
14:14 --> 14:17but we're not really seeing as much here,
14:17 --> 14:20so that that's an association.
14:20 --> 14:22But these are all really
14:22 --> 14:26at the stage of thought experiments
14:26 --> 14:28and hypothesis, even despite
14:28 --> 14:31a lot of research we have not
14:31 --> 14:33really come up with the
14:33 --> 14:35answer and so an important thing I
14:35 --> 14:37tell families and I say it honestly
14:37 --> 14:39is that there is nothing known
14:39 --> 14:43that you could have done
14:43 --> 14:44to prevent this.
14:44 --> 14:47And there's nothing that you could
14:47 --> 14:49have done to screen for this,
14:49 --> 14:52because until it declares itself,
14:52 --> 14:54there's no way to know.
14:54 --> 14:56There is no technique available,
14:56 --> 14:58total body testing
14:58 --> 15:00that could identify it
15:00 --> 15:03earlier and children are often l
15:03 --> 15:05well until they're not well,
15:05 --> 15:07that's just a phenomenon,
15:07 --> 15:10and there's no test to catch it earlier,
15:10 --> 15:12so I think that's a very,
15:12 --> 15:14very important message for parents
15:14 --> 15:16and family members to hear.
15:16 --> 15:18I think it's also important because
15:18 --> 15:21sometimes cancer can be really stigmatizing,
15:21 --> 15:23and I think that it's important
15:23 --> 15:26to know that these are really
15:26 --> 15:28good parents that just had a
15:28 --> 15:30very unlucky thing happen.
15:34 --> 15:37We're going to pick up this whole
15:37 --> 15:39conversation about cancer in
15:39 --> 15:41children right after we take a
15:41 --> 15:43short break for a medical minute.
15:43 --> 15:45Please stay tuned to learn more
15:45 --> 15:47about pediatric cancers with my
15:47 --> 15:49guest Doctor Nina Kadan-Lottick.
15:49 --> 15:51Support for Yale Cancer Answers
15:51 --> 15:53comes from AstraZeneca, working to
15:53 --> 15:56eliminate cancer as a cause of death.
15:56 --> 15:59Learn more at astrazeneca-us.com.
15:59 --> 16:01This is a medical minute
16:01 --> 16:02about pancreatic cancer,
16:02 --> 16:05which represents about 3% of all cancers
16:05 --> 16:09in the US and about 7% of cancer deaths.
16:09 --> 16:11Clinical trials are currently being
16:11 --> 16:12offered at federally designated
16:12 --> 16:15comprehensive Cancer Centers for the
16:15 --> 16:17treatment of advanced stage and metastatic
16:17 --> 16:19pancreatic cancer using chemotherapy
16:19 --> 16:20and other novel therapies.
16:20 --> 16:21FOLFIRINOX
16:21 --> 16:23is a combination of five different
16:23 --> 16:26chemotherapies and is the latest advance in
16:26 --> 16:28the treatment of metastatic pancreatic
16:28 --> 16:30cancer and research continues at
16:30 --> 16:32centers around the world
16:32 --> 16:34looking into targeted therapies
16:34 --> 16:36and a recently discovered marker
16:36 --> 16:39HENT one. This has been a medical
16:39 --> 16:41minute brought to you as a public
16:41 --> 16:43service by Yale Cancer Center.
16:43 --> 16:45More information is available at
16:45 --> 16:47yalecancercenter.org you're listening
16:47 --> 16:48to Connecticut Public Radio.
16:49 --> 16:52Welcome back to Yale Cancer Answers.
16:52 --> 16:55This is doctor Anees Chagpar and I'm
16:55 --> 16:58joined tonight by my guest doctor Nina Kadan Lottick
16:58 --> 17:00and we're discussing pediatric
17:00 --> 17:03cancers and this is always
17:03 --> 17:05a topic that is heartbreaking.
17:05 --> 17:08Whether you hear about it on the radio,
17:08 --> 17:11you see commercials on TV or you
17:11 --> 17:13know somebody personally whose
17:13 --> 17:15child is going through cancer.
17:15 --> 17:17It's always something where
17:17 --> 17:18your heart really breaks.
17:18 --> 17:21But Nina, right before the break,
17:21 --> 17:24you were talking a little bit about
17:24 --> 17:26genomics and personalized medicine.
17:26 --> 17:29How in these kids we can now
17:29 --> 17:31do this genomic profiling?
17:31 --> 17:34See what genes are turned on and turned
17:34 --> 17:37off in particular cancers and tailor
17:37 --> 17:40our therapy, does that happen
17:40 --> 17:43on all pediatric centers or do
17:43 --> 17:46you need to be at a big academic
17:46 --> 17:48University to have that done?
17:50 --> 17:53So I do think it helps to be at a
17:53 --> 17:56big academic University to have it
17:56 --> 17:58be done more widely.
17:58 --> 18:01Some of those tests have
18:01 --> 18:04entered standard of care,
18:04 --> 18:09but some of them are still
18:09 --> 18:11only available in a research context,
18:11 --> 18:14but are known to be quite valuable
18:14 --> 18:16and helpful in guiding therapy,
18:16 --> 18:19so we're really pleased to be
18:19 --> 18:21able to offer that at Yale,
18:21 --> 18:24both for all the different tumor types.
18:24 --> 18:27I will say that we're learning a lot,
18:27 --> 18:29and it's more helpful for
18:29 --> 18:31some tumor types than others,
18:31 --> 18:34but we have learned in general
18:34 --> 18:36that for pediatric cancers
18:36 --> 18:38that risk stratification is
18:38 --> 18:40really important and the risk
18:40 --> 18:43category a cancer is in, or sub
18:43 --> 18:46category it's in can depend on which
18:46 --> 18:50genes are turned on or off and even other
18:50 --> 18:53patient attributes like age or response
18:53 --> 18:56to the first round of chemotherapy,
18:56 --> 19:01those help us know how to fine tune
19:01 --> 19:04the treatment path so that we can get
19:04 --> 19:07to cure.
19:07 --> 19:10Tell us more about how that all happens
19:10 --> 19:13so you know we've gotten to the
19:13 --> 19:16point where the child has come in,
19:16 --> 19:18seen the pediatrician, gotten the
19:18 --> 19:22scans and the blood work, had the biopsy,
19:22 --> 19:25and let's suppose has cancer.
19:28 --> 19:30You had mentioned that the
19:30 --> 19:33survival rates are really good.
19:33 --> 19:36Many of these kids will have long term cures,
19:36 --> 19:39and there are a lot of exciting
19:39 --> 19:40treatments coming down the Pike.
19:40 --> 19:43Tell us a little bit more about that,
19:44 --> 19:47and what kind of gives you hope in this space?
19:49 --> 19:55So to give you examples, in leukemia,
19:56 --> 20:00there are certain markers on the surface
20:00 --> 20:02of the leukemia cells
20:02 --> 20:04that are proteins that live
20:04 --> 20:07on top of the tumor cells and
20:07 --> 20:08we can engage,
20:08 --> 20:11we use drugs that engage the
20:11 --> 20:14bodies own immune system
20:14 --> 20:17to attack those cells that have
20:17 --> 20:18those proteins selectively.
20:18 --> 20:22And that has two really important benefits.
20:22 --> 20:25One of them is that
20:25 --> 20:28it kills the cancer cells and
20:31 --> 20:33second is that there's less
20:33 --> 20:35collateral damage or unintended
20:35 --> 20:37consequences to the healthy tissue.
20:37 --> 20:39Because conventional chemotherapy just
20:39 --> 20:42works on a lot of different cells,
20:42 --> 20:44any rapidly dividing cells,
20:44 --> 20:46but we have healthy cells in
20:46 --> 20:49our body that divide rapidly,
20:49 --> 20:52and so that's what can cause a lot
20:52 --> 20:55of problems with with the misery of
20:55 --> 20:58going through some of the chemotherapy.
20:58 --> 20:59So that's one example.
20:59 --> 21:01We also have understood
21:01 --> 21:04a little better how tumors
21:04 --> 21:06trick the immune system.
21:06 --> 21:08So that they get the nutrients they
21:08 --> 21:13need to divide quickly, or that they
21:13 --> 21:16keep the bodies own immune system from
21:16 --> 21:19getting rid of them as
21:19 --> 21:21we have an immune system that
21:21 --> 21:24polices our body all the time.
21:24 --> 21:26You get rid of abnormal cells and somehow
21:26 --> 21:29these tumor cells escaped that system.
21:29 --> 21:31So we also utilized that.
21:31 --> 21:35And these drugs are available
21:35 --> 21:39across tumor groups we're discovering them
21:41 --> 21:43and to know whether a tumor
21:43 --> 21:46would be amenable to that
21:46 --> 21:49we do tests on the tumor, one including
21:49 --> 21:51the kind of proteins they make,
21:51 --> 21:54and another is what the genetic
21:54 --> 21:56makeup of the tumor cell is.
21:56 --> 22:00So those are some examples.
22:00 --> 22:03A new initiative that we have
22:03 --> 22:04with Doctor Marks is
22:04 --> 22:07another exciting one is that in brain tumors,
22:07 --> 22:10children with neurofibromatosis are one
22:10 --> 22:13of the groups that have an increased
22:13 --> 22:16risk of brain cancers called gliomas.
22:16 --> 22:18And there is a certain kind of
22:18 --> 22:21drug called a MEK inhibitor that
22:21 --> 22:24is specifically good for
22:24 --> 22:26neurofibromatosis patients,
22:26 --> 22:30given the kind of genetic findings that
22:30 --> 22:34are in their tumor cells.
22:35 --> 22:36And so you know
22:36 --> 22:39this is really great that there
22:39 --> 22:42are targeted therapies that address
22:42 --> 22:45particular proteins in particular cancers,
22:45 --> 22:48or that help the immune system to
22:48 --> 22:51attack certain cancers that might
22:51 --> 22:54be trying to sneak away from being
22:54 --> 22:57attacked by the immune system.
22:57 --> 23:01A lot of this has to do with research,
23:01 --> 23:04and we talked a little bit
23:04 --> 23:07on this show about clinical trials.
23:09 --> 23:12What is your advice when it comes to
23:12 --> 23:14clinical trials for kids and cancer?
23:14 --> 23:15So number one,
23:15 --> 23:18are there clinical trials that are
23:18 --> 23:21available to kids who have cancer and two,
23:21 --> 23:24what is your advice to parents?
23:24 --> 23:26For many parents they may be thinking,
23:26 --> 23:27don't experiment
23:27 --> 23:30on my child, I'll take standard of care,
23:30 --> 23:32thank you very much,
23:32 --> 23:34especially a standard of care
23:34 --> 23:35that is doing pretty well.
23:35 --> 23:37On the other hand,
23:37 --> 23:41we often talk about clinical trials,
23:41 --> 23:43really offering patients kind
23:43 --> 23:44of tomorrow's therapies today,
23:44 --> 23:47and that many patients actually benefit
23:47 --> 23:50from being in clinical trials. Talk a
23:50 --> 23:52little bit about the particulars
23:52 --> 23:55of clinical trials when it comes
23:55 --> 23:57to pediatric patients with cancer.
23:59 --> 24:01So I do think that's one of
24:01 --> 24:03the reasons why children have
24:03 --> 24:05been doing so well with cancer.
24:05 --> 24:07That wasn't the case a
24:07 --> 24:10generation ago, 30 years ago,
24:10 --> 24:12the cure rates were
24:14 --> 24:20less than half what they are now, and
24:20 --> 24:25if I had had a cancer as a child most likely,
24:25 --> 24:28and I'm a little older than that,
24:28 --> 24:31I would have likely succumbed.
24:31 --> 24:34So things have changed very quickly,
24:34 --> 24:36and pediatrics has really taken the
24:36 --> 24:39lead in organizing sites across
24:39 --> 24:41the country together to coordinate
24:41 --> 24:43and do clinical trials together.
24:43 --> 24:46And we have a very high rate of
24:46 --> 24:50clinical trial enrollment around 80%
24:50 --> 24:52and there have been analysis
24:52 --> 24:54that show taking all comers,
24:54 --> 24:57patients who are in clinical trials do
24:57 --> 24:59better than those who do not enroll.
24:59 --> 25:01In terms of experimentation,
25:01 --> 25:04I would say that the well being of the
25:04 --> 25:07children in our care is the absolute top
25:07 --> 25:10priority and there is no conflict of
25:10 --> 25:12interest about personally benefiting of
25:12 --> 25:15someone going on a clinical trial or not.
25:15 --> 25:18It's really to offer what's best and
25:21 --> 25:24we have over 30 therapeutic pediatric
25:24 --> 25:28trials now and more in the pipeline.
25:28 --> 25:30It goes through a very rigorous
25:30 --> 25:31scientific review.
25:31 --> 25:33We will not open a study that we don't feel
25:33 --> 25:36can offer meaningful benefit for children,
25:36 --> 25:38so it won't even open here.
25:38 --> 25:41We won't even have it to offer.
25:41 --> 25:43And before we've all reviewed it
25:43 --> 25:45and reviewed it very rigorously.
25:45 --> 25:48And then it's of course the parents decision,
25:48 --> 25:51but we try to lay out what
25:51 --> 25:53are the potential benefits and
25:53 --> 25:56what are the potential risks and then to
25:56 --> 25:59make that decision in a tough time when
25:59 --> 26:02you don't want to have cancer at all,
26:02 --> 26:05we don't want you to have it at all
26:05 --> 26:07to have to make that decision for
26:07 --> 26:10conditions in which there's outstanding
26:10 --> 26:12outcomes and there's almost 100%
26:12 --> 26:15cure rate or above 95% cure rates.
26:15 --> 26:17We don't really have trials open
26:17 --> 26:20because we don't feel like there's
26:20 --> 26:21as much meaningful to offer,
26:21 --> 26:24and the standard of care is reasonable.
26:24 --> 26:28But for most parents
26:28 --> 26:31if you can increase a cure rate
26:31 --> 26:34probability from 80% to 87% or 90%,
26:34 --> 26:38that would be something to consider if
26:38 --> 26:41the rest of the risk benefit equation
26:42 --> 26:43were reasonable,
26:43 --> 26:47and so that's why we always try
26:47 --> 26:49to push that envelope,
26:49 --> 26:52because I'm happy about 85% all comers.
26:52 --> 26:54But I don't think that's
26:54 --> 26:56high enough for our children.
26:56 --> 26:59That's 15% of children
26:59 --> 27:01who are not making it and it
27:01 --> 27:03needs to be higher.
27:03 --> 27:06It needs to be as close to as
27:06 --> 27:09100% as we can get it.
27:09 --> 27:12Absolutely and the other question
27:12 --> 27:16that I think many parents may have is,
27:16 --> 27:19regardless of what therapy children undergo,
27:19 --> 27:21whether it's a targeted therapy,
27:21 --> 27:24whether it's standard of care,
27:24 --> 27:27whether it is a novel therapy that's
27:27 --> 27:30being offered on a clinical trial,
27:30 --> 27:32many patients, and many parents may
27:32 --> 27:36ask what are the long term sequelae
27:36 --> 27:38of cancer treatment in childhood.
27:38 --> 27:40So in other words,
27:40 --> 27:44if my child takes chemotherapy now,
27:44 --> 27:46what does that do to their
27:46 --> 27:47cognitive development?
27:47 --> 27:50What does that do to their
27:50 --> 27:52fertility down the line?
27:52 --> 27:56What does that do to
27:56 --> 27:58their propensity to pass along
27:58 --> 28:02a risk to their future generations?
28:02 --> 28:04What do you advise patients and
28:04 --> 28:07parents when they are concerned
28:07 --> 28:09about these long-term sequelae?
28:10 --> 28:13So that's a very robust area of research.
28:13 --> 28:17We now have the luxury and the
28:17 --> 28:21pleasure of seeing and caring for long term
28:21 --> 28:25survivors who have lived many decades past
28:25 --> 28:28their cancer experience so we can
28:28 --> 28:30quantify that risk, and that's what we
28:30 --> 28:33do in the Heroes Clinic, which I direct.
28:33 --> 28:36We care specifically for survivors after
28:36 --> 28:39their treatment ended to keep them as healthy
28:39 --> 28:41as possible and to manage any complications,
28:41 --> 28:44because unfortunately we have learned
28:44 --> 28:46that the therapies that were needed
28:46 --> 28:48to cure the cancer can sometimes
28:48 --> 28:50cause downstream health effects,
28:50 --> 28:53and you listed some of them.
28:53 --> 28:55So for some therapies they
28:55 --> 28:56can result in infertility.
28:56 --> 28:59We have a proactive fertility preservation
28:59 --> 29:02program so that we try to
29:02 --> 29:05offer egg harvest when we can,
29:05 --> 29:07and we manage and screen for problems
29:07 --> 29:11to try to catch them before they happen.
29:11 --> 29:14We're also doing a lot of research
29:14 --> 29:15because we've learned that
29:15 --> 29:18exercise and diet can make a meaningful
29:18 --> 29:21difference in undoing the effects of the
29:21 --> 29:22previous cancer and radiation therapy,
29:23 --> 29:25so I think that to stay healthy
29:25 --> 29:27and to live the best life,
29:27 --> 29:30there needs to be long term
29:30 --> 29:32follow up to make sure that if there
29:32 --> 29:35are problems they are caught early and for
29:35 --> 29:37cognitive problems that may mean also
29:37 --> 29:40screening people early so they get
29:40 --> 29:41the best education intervention that
29:41 --> 29:44they can to meet their full potential.
29:45 --> 29:47Doctor Nina Kadan-Lottick is the
29:47 --> 29:50medical director of the Heroes Program,
29:50 --> 29:52and an associate professor of
29:52 --> 29:53Pediatrics in hematology oncology
29:53 --> 29:56at the Yale School of Medicine.
29:56 --> 29:58If you have questions, the address
29:58 --> 30:00is canceranswers@yale.edu and pass.
30:00 --> 30:01Editions of the program are
30:01 --> 30:03available in audio and written
30:03 --> 30:04form at yalecancercenter.org.
30:04 --> 30:07We hope you'll join us next week to
30:07 --> 30:09learn more about the fight against
30:09 --> 30:11cancer here on Connecticut Public Radio.

Information

Pediatric Cancer Survivorship during COVID with guest Dr. Nina Kadan-Lottick March 7, 2021 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095