Gene Expression Predicts Neuroblastoma Outcome

Among children with neuroblastoma, a test that assesses the activity of several genes in a sample of tumor tissue provides information about the patient’s prognosis and may help guide treatment decisions. The results of this study were published in Lancet Oncology.

Neuroblastoma—a cancer that develops in nerve tissue of the adrenal gland, neck, chest, or spinal cord—most commonly occurs in infants and children, and has highly variable treatment outcomes. Some patients can be cured with relatively simple treatments, while others have poor outcomes even with very intensive treatment.

In order to provide the most appropriate treatment for neuroblastoma, physicians use several pieces of information to try to predict whether a neuroblastoma patient is at high or low risk of treatment failure and cancer progression. Patients at low risk may be able to avoid intensive therapy, whereas patients at high risk may proceed directly to intensive therapy or participation in a clinical trial. Important progress has been made in risk-adapted treatment, but there is still room for improvement.

For several types of cancer, research suggests that the activity of certain genes within the cancer itself influences cancer behavior and response to therapy. To explore the role of a gene expression test in neuroblastoma, researchers in Europe developed and tested a 59-gene test.

The gene expression test was found to be a strong predictor of both overall and progression-free survival, even after accounting for standard neuroblastoma risk factors.

The researchers recommend additional evaluation of this test. Eventually, this test could help determine which neuroblastoma patients need intensive therapy, such as a stem cell transplant, and which patients can be treated with less aggressive and less toxic therapies.

Reference: Vermeulen J, De Preter K, Naranjo A et al. Predicting outcomes for children with neuroblastoma using a multigene-expression signature: a retrospective SIOPEN/COG/GPOH study. Lancet Oncology. Early online publication June 9, 2009.

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