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Research over the last few decades has led to a better understanding of cancer genetics. The clinical application of this knowledge to pediatric cancer has lagged behind studies conducted in adults. In a perspective article published in the journal ScienceDr. Jaclyn Biegel of the Los Angeles Children's Hospital and Dr. Alejandro Sweet-Cordero of the University of California, San Francisco, examine the landscape of this young field and present opportunities for Use of genomic information to advance a new era of care for children with cancer.
Cancer results from genetic modifications, including DNA mutations, present at birth or acquired over time. Many adult cancers are caused by mutations acquired through exposure to substances such as smoking and radiation or simply through aging. Tumors can contain hundreds of sequence modifications and identify the changes that lead to tumor growth, and the impact of the response to treatment can be difficult. In contrast, malignant tumors in children often develop from a very small number of mutations, some of which only overlap with the types of mutations observed in adult cancers. In addition, it is estimated that 20% of pediatric cancers occur in children who have a genetic predisposition to malignancy. For this reason, clinical genetic tests developed to inform prognosis and treatment decisions for adult cancers have not been as helpful in pediatrics.
OncoKids® was one of the first new generation sequencing panels to detect changes in DNA and RNA that characterize pediatric cancers. The panel was developed at the Los Angeles Children's Hospital under the direction of author Jaclyn Biegel, PhD, FACMG, Director of the CHLA Center for Personalized Medicine. The OncoKids® panel provides molecular diagnostics, prognostic information and new therapeutic targets for the broad spectrum of childhood cancers, including leukemias, brain tumors and other solid tumors.
"To truly get personalized medicine in pediatric oncology, we need to be able to determine if a child is genetically predisposed to developing cancer," said Dr. Biegel. In addition to tumor testing, germline tests using a patient's blood sample are essential to identify children at genetic risk of developing cancer in the future. In addition to benefiting the patient, this information has implications for the entire family, since a parent-to-child anomaly can also increase the risk of cancer in siblings.
Although tremendous progress has been made in the treatment of pediatric cancer, treatment-resistant diseases and relapses continue to have a negative impact on patient outcomes. The genetic profile of pediatric cancers is usually established at the time of diagnosis or at the time of relapse to help determine the treatment plan. According to Dr. Biegel, future studies that could be done during treatment and remission could provide crucial insights into the mechanisms of tumor progression, resistance to treatment, and metastasis.
There is a tremendous opportunity to change outcomes in children with cancer by using an integrated approach to badess children and their families, which includes genomic medicine as a central component of their care.
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Material provided by Los Angeles Children's Hospital. Note: Content can be changed for style and length.
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