New MIBG therapy at Children's offers relapsed neuroblastoma patients advanced treatment option
First therapy location in New England
January 27, 2009
Boston, Mass. - Children's Hospital Boston is offering a new therapy that uses radioiodine labeled metaiodobenzylguanidine (I-131 MIBG) to treat patients with relapsed neuroblastoma. It is the first therapy of its kind to be offered in New England.
Neuroblastoma is a cancerous tumor that begins in nerve tissue of infants and very young children. It usually occurs in the abdomen but can occur in other sites near the spine and spread quickly to other areas of the body. It affects roughly 600 children a year in the United States and can have a varied clinical presentation - some cases are localized and easy to treat, while more than half of the children have aggressive disease that has spread at diagnosis and is much harder to cure.
Conventional treatments for neuroblastoma include surgery, local radiation and high-dose chemotherapy. "We are always looking for novel ideas and strategies to try to cure relapsed patients whose neuroblastoma is resistant to traditional treatments," said Suzanne Shusterman, MD, attending physician at Children's Hospital Boston and Dana-Farber Cancer Institute who oversees the neuroblastoma program. "I-131 MIBG is one of the most effective therapies for children with relapsed neuroblastoma, with a response rate of almost forty percent. While it doesn't cure, I-131 MIBG can allow patients to gain control of their disease and, in combination with other treatments, bring them closer to being cured."
Originally developed as a blood pressure medicine, MIBG is a compound that is selectively absorbed by certain types of nervous tissue, including neuroblastoma cells. For many years it has been used diagnostically to determine where cancerous activity is occurring within the body. More recently, oncologists began using it to deliver targeted radiation to neuroblastoma cells by binding it to a radioactive isotope of iodine (I-131). Once bound together, the radioactive MIBG is administered to a child through an intravenous line (IV) and absorbed by tumor cells, which are killed by the radiation emitted by the radioactive I-131. Children's is the only center in New England, and just one of a handful in the United States, offering this advanced treatment.
"This treatment is a way of targeting radiation to kill tumors while sparing normal tissues," said Lisa Diller, MD, clinical director of Pediatric Oncology at Dana-Farber Cancer Institute and Children's Hospital Boston. "We are very excited that I-131 MIBG will be an important therapy in eradicating neuroblastoma."
The actual infusion of I-131 MIBG is a short procedure, lasting approximately one to two hours. Because this treatment involves delivering high doses of radiation, a patient will stay in a specially designed room in the hospital for three to seven days after the infusion.
The I-131 MIBG room is a 256 square-foot hospital room located in the stem cell transplant unit on the sixth floor of Children's Hospital. The room has added protective features to help manage the therapy safely for the benefit of both patients and staff, and has an anteroom where parents may stay to help with the care of their child and be in close proximity throughout the therapy. During the day parents may safely spend time with their child following specific safety procedures designed to protect them as well as the hospital staff.
When a child is hospitalized for I-131 MIBG therapy, parents and caregivers will be considered an active member of their child's care team and will be closely involved in delivering routine care. The carefully selected and trained team of healthcare specialists will clearly explain these safety procedures and responsibilities to parents before scheduling treatment.
Compared to chemotherapy, I-131 MIBG is very well tolerated and affords a good quality of life for patients traditionally overwhelmed with hospital visits. The most common side effects are low platelets and low white blood cell counts about a month after receiving the treatment, both of which can be easily managed. Follow up visits to the hospital are also limited, most often taking place six to eight weeks after the date of infusion.
Almost all patients report at least a subjective response to I-131 MIBG. "The nice thing with I-131 MIBG is that most patients, even patients who don't have a response that we can see by standard imaging techniques, have a decrease in their level of pain and improvement in their quality of life," continued Shusterman.
S. Ted Treves, MD, chief of the Division of Nuclear Medicine at Children's, commented, "The availability of this therapy demonstrates a true team effort and commitment from experts in multiple disciplines across the hospital - from Pediatric Oncology to Nursing, Child Life, Nuclear Medicine, and Radiation Safety."
"Together, using our various areas of expertise, we are dedicated to having this treatment available at Children's and ensuring that it is delivered safely and effectively," continued William "Rusty" Lorenzen, MS, who serves as the institution's radiation safety officer.
For more information on I-131 MIBG therapy and to find out if I-131 MIBG is a possible treatment option, please contact the New Patient Coordinator at Dana-Farber/Children's Hospital Cancer Center at 888-Pedi-Onc (733-4662).
Dana-Farber/Children's Hospital Cancer Center (DF/CHCC) represents the integrated pediatric oncology program at Children's Hospital Boston and Dana-Farber Cancer Institute. The more than 60-year-old program offers comprehensive care to children, adolescents, young adults, and survivors of all types of childhood cancers and related diseases. For more information about DF/CHCC visit: http://www.dana-farber.org/pat/pediatric-care.
Children's Hospital Boston is home to the world's largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869. More than 500 scientists, including eight members of the National Academy of Sciences, 11 members of the Institute of Medicine and 13 members of the Howard Hughes Medical Institute comprise Children's research community. Founded as a 20-bed hospital for children, Children's Hospital Boston today is a 397-bed comprehensive center for pediatric and adolescent health care grounded in the values of excellence in patient care and sensitivity to the complex needs and diversity of children and families. Children's also is the primary pediatric teaching affiliate of Harvard Medical School. For more information about the hospital and its research visit: www.childrenshospital.org/newsroom.
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Dr. Shusterman discusses neuroblastoma and the new MIBG therapy offered at Children's.