New service transforms childhood cancer treatment

Children with cancer should benefit from a service that, for the first time, will allow doctors to personalize their treatment.

The Therapeutic Monitoring Service, developed by Newcastle University experts, provides clinicians with essential information on how much chemotherapy each young patient should receive.

Young people with cancer, including infants during the first few weeks of life, can be particularly difficult to treat because it is difficult to know how much chemotherapy to administer.

Doctors sometimes have to make difficult decisions regarding the most appropriate drug dosage, without having enough scientific data to help them decide on the best course of action.

Drug monitoring

The service was created at the request of physicians from Great North Children's Hospital, Newcastle, UK, and other front-line treatment centers for the treatment of childhood cancer in the UK -United.

It works by taking blood samples after administration of chemotherapy on the first day of treatment. The samples are badyzed in real time to measure each patient's drug exposure, the results generated being used to adjust the dosage accordingly.

The amount of chemotherapy administered in the following days is then set so that the patient receives the dose most likely to be effective, but without causing too much toxicity, such as illness and diarrhea.

Prof. Gareth Veal of the Northern Institute for Cancer Research at the University of Newcastle is leading this program, which is already benefiting many patients.

He said: "Establishing the correct dose of cancer treatment in very young patients has long been a major clinical challenge, as physiologic changes in development can have a marked impact on the effects of a cancer. drug once it has been administered.

"If the patient is under-dosed, the tumor may not respond to treatment, whereas if the patient is overdosed, he is likely to experience more adverse drug effects.

"It is difficult to predict what happens to a drug after its administration in terms of how effectively it is broken down and eliminated from the body.

"Our therapeutic drug monitoring service involves measuring drug levels in patients with childhood cancer during treatment and changing the dose of medication given to them to achieve the best clinical outcome."

Need service

Before service, clinicians set the dose of chemotherapy for the infant or the child based on the weight and age of the patient, with a "one size fits all" model.

Gail Halliday, pediatric oncology consultant at the NHS Hospitals NHS Foundation Trust, said: "The Therapeutic Drug Monitoring Service has transformed the way young cancer patients are treated and the positive results they achieve.

"Previously, it was a guessing game as to the most appropriate chemotherapy dose for each child, whereas now we can rest badured that what we are giving is correct.

"In the past, the risk factors were either your insufficient dose, and if the tumor recurred, it would be harder to cure or your overdose and the child would have sustained effects of its toxicity.

"It is essential to do everything in our power to give every patient the best chance to respond effectively to treatment, while minimizing the risk of adverse drug reactions.

"Now we are confident that we are achieving a standard of excellence care and it is thanks to the University of Newcastle team that this is possible."

Further research

The service has been running at the Great North Children's Hospital for a few years, but the National Institute of Health Research has provided funding to the University of Newcastle for the completion of a study of three years to expand the service nationwide.

Professor Veal said: "This will not only have a positive impact on the patients recruited in the study, but will also generate data that will have a significant impact on the future treatment of patients through the provision of national guidelines for patients. anticancer drugs in defined patient populations ".

The Therapeutic Drug Monitoring Service is among the finalists in the Bright Ideas in Health Awards, which celebrates the achievements of NHS members, industry and academia in improving patient care. The awards ceremony will be held later this week.

History of the patient

The small Blazej Sarnicki is lucky to be alive after the most difficult years of his young life.

In 2016, he was diagnosed with aggressive Wilms tumors in both kidneys and is currently on dialysis three times a week after both organs have been removed to save his life.

The young man was several times in intensive care at Great North Children's Hospital and it was difficult to know whether he would survive or not. In the future, he will need a kidney transplant.

Blazej was one of the first to benefit from the therapeutic follow-up service because it required intensive chemotherapy and doctors had to adjust his dose to his individual medical needs.

His mother, 38-year-old teacher Monika, said, "It's great to see how good Blazej is and it's thanks to the treatment he's received that he's doing so well.

"We were wiped out by the diagnosis of Wilms tumors at Blazej because we had never heard of the disease and sometimes thought we were going to lose it."

"I know that the Therapeutic Follow-Up Service has given him the best personalized treatment, and the medical team worked hard to help Blazej.

"Having such a service in Newcastle is of great benefit to the Northeast and beyond."

Blazej is back at school and enjoys life with his twin brother, Oliwier, his sister, Julia, nine, and his parents, Monika and Grezegorz.

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