Neuroblastoma and Cancer Survivorship
The focus of our research is in two major areas: the treatment of patients with solid tumors - notably neuroblastoma and Wilms' tumor - and the study of survivors of childhood cancer.In treating patients with neuroblastoma, our approach has been to intensify therapy using high-dose therapy in tandem with stem cell rescue. In addition, we are studying new approaches to the treatment of minimal residual neuroblastoma, including antiangiogenic agents, demethylating agents, and immunomodulatory approaches. (We are participants in the New Agents in Neuroblastoma Therapy consortium.) Studies of survivors of neuroblastoma are also under way. In research on medical late effects, we have been studying young adult patients with a history of cancer treatment, hoping to delineate the morbidity of a variety of therapies and to introduce screening and prevention in this group of patients. We also have completed an early mammography trial after chest irradiation, showing that women who were treated with chest radiation are at significant risk of breast cancer and that mammography detects early tumors in this cohort. A prevention trial using tamoxifen for these women is in analysis. Moreover, we are active participants in the largest childhood cancer survivor cohort study, the Childhood Cancer Survivor Study, involving 24 centers and over 17,000 survivors. We have completed an analysis of breast cancers in that cohort, and are studying risk factors for secondary sarcomas. Interventional studies using the same cohort are under way, including a web-based smoking cessation intervention, an analysis of breast cancer screening behaviors, and a planned study of renal disease screening.