Molecular Events, Not Time, Define Pediatric Oncology Outcomes

Interview Transcript (modified slightly for readability):

Kolb: “It’s another difference between children and adults in the oncology world. In adults, we think about cancers progressing from stage 1, to stage 2, to 3, to 4, [and] we think about early diagnosis and screening programs—those paradigms don’t apply as well to pediatrics.

When children present [with] or are diagnosed with a pediatric cancer, it’s usually because the cancer has become such a burden to the child [that] it’s obvious. Often when I talk to pediatricians who referred a patient in [to a pediatric oncologist], the patient may have presented a couple of times with fever, fatigue, weight loss, or common symptoms pediatricians see every day that are in children who don’t have cancers.

It’s very hard to tease out the specific symptoms associated with a pediatric cancer in that [general pediatrician] setting. Doing a complete physical exam, doing lab work up when indicated—these are recommendations for identifying children with cancer; but I don’t think there really is much of an opportunity for screening or early diagnosis.

I think it’s also reassuring that [for] many of the pediatric cancers—the [associated] risks and survival—are defined by molecular events, not by time. The moment that first cancer cell forms, in many patients, the fate of the treatment or prognosis is defined. It’s not necessarily that the patient was diagnosed late, so the tumor got big or the tumor metastasized, it’s the molecular events that define the prognostic outcome."

At the American Society of Clinical Oncology (ASCO) 2018 annual meeting in Chicago, Illinois, E. Anders Kolb, MD, director of Nemours Center for Cancer and Blood Disorders at Nemours/Alfred I. duPont Hospital for Children, outlined the challenges in diagnosing pediatric cancers and explained how molecular events define disease outcomes