A new study showing significantly improved survival rates for patients with stage IV Wilms tumors with lung metastases was recently published in the Journal of Clinical Oncology. The outcomes of the study, "Treatment of Stage IV Favorable Histology Wilms Tumor With Lung Metastases: A Report From the Children's Oncology Group AREN0533 Study," will be a game-changer in treating Wilms tumor and reduce the need for radiation -- and the long-term risks associated with it -- in nearly half of patients whose cancer has spread to the lung. The study was led by Jeffrey Dome, M.D., Ph.D., vice president for the Center for Cancer and Blood Disorders at Children's National Health System.
Wilms tumor, which starts in the kidneys, is the fifth most common cancer in children under 15 years old. Although outcomes for most patients are outstanding, patients with metastatic disease, with the lung as the most common site of spread, fare worse than patients with localized disease. Their treatment is also complicated by a risk of health problems later in life, including cardiac dysfunction and second malignancies, which are most closely related to the use of lung radiation therapy (RT) and the chemotherapy drug doxorubicin.
The standard treatment for Wilms tumor with lung metastases in North America is to give "3-drug" chemotherapy (vincristine/dactinomycin/doxorubicin) and lung RT. The AREN0533 study assessed whether lung RT can be avoided for patients with complete lung nodule response after six weeks of chemotherapy. Conversely, the study assessed the benefit of adding two additional chemotherapy agents, cyclophosphamide and etoposide, to the treatment regimen for patients with incomplete lung nodule response, a treatment strategy that was associated with inferior outcomes in previous studies. AREN0533 was also the first study in Wilms tumor to modify treatment based on an adverse biological prognostic factor, loss of heterozygosity (LOH) at chromosomes 1p and 16q. The study showed:
"These findings will change clinical practice and improve survival for patients with Wilms tumor whose cancer has spread to the lungs" said Dr. Dome. "The risk-adapted approach to treatment based on tumor biology and tumor response provides a framework for future studies as we come one step closer to achieving 100 percent survival without treatment-associated side effects."
Materials provided by Children's National Health System. Note: Content may be edited for style and length.
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