Pharmacotherapeutic Management of Wilms Tumor: An Update

Although differences exist in treatment and risk-stratification strategies for children with Wilms tumor (WT) between the European [International Society of Paediatric Oncology (SIOP)] and American [Children’s Oncology Group (COG)] study groups, outcomes are very similar, with an overall survival of...

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Bibliographic Details
Published in:	Paediatric drugs Vol. 21; no. 1; pp. 1 - 13
Main Authors:	Oostveen, Radna Minou, Pritchard-Jones, Kathy
Format:	Journal Article
Language:	English
Published:	Cham Springer International Publishing 01-02-2019 Springer Springer Nature B.V
Subjects:	Antineoplastic Agents - therapeutic use Cancer therapies Care and treatment Chemotherapy Child Children & youth Consortia Drug Therapy Evaluation Histology Humans Internal Medicine Kidney Neoplasms - drug therapy Kidney Neoplasms - pathology Leading Article Medical prognosis Medicine Medicine & Public Health Metastasis Neoplasm Recurrence, Local - prevention & control Neoplasm Staging Nephroblastoma Oncology Pediatrics Pharmacogenetics Pharmacokinetics Pharmacotherapy Radiation therapy Risk factors Studies Surgery Tumors Wilms Tumor - drug therapy Wilms Tumor - pathology United Kingdom
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Summary:	Although differences exist in treatment and risk-stratification strategies for children with Wilms tumor (WT) between the European [International Society of Paediatric Oncology (SIOP)] and American [Children’s Oncology Group (COG)] study groups, outcomes are very similar, with an overall survival of > 85%. Future strategies aim to de-intensify treatment and reduce toxicity for children with a low risk of relapse and intensify treatment for children with high-risk disease. For metastatic WT, response of lung nodules to chemotherapy is used as a marker to modify treatment intensity. For recurrent WT, a unified approach based on the use of agents that were not used for primary therapy is being introduced. Irinotecan is being explored as a new strategy in both metastatic and relapsed WT. Introduction of biology-driven approaches to risk stratification and new drug treatments has been slower in WT than in some other childhood cancers. While several new biological pathways have been identified recently in WT, their individual rarity has hampered their translation into clinical utility. Identification of robust prognostic factors requires extensive international collaborative studies because of the low proportion who relapse or die. Molecular profiling studies are in progress that should ultimately improve both risk classification and signposting to more targeted therapies for the small group for whom current therapies fail. Accrual of patients with WT to early-phase trials has been low, and the efficacy of these new agents has so far been very disappointing. Better in vitro model systems to test mechanistic dependence are needed so available new agents can be more rationally prioritized for recruitment of children with WT to early-phase trials.
ISSN:	1174-5878 1179-2019
DOI:	10.1007/s40272-018-0323-z