Thursday, December 27, 2012
Complete Remission Following a Dendritic Cell- Cancer Testis Antigen Vaccine for Chemotherapy Refractory Neuroblastoma
A manuscript published in the January issue’s Case Report section brings to attention the course of a five year old child with multiply relapsed neuroblastoma that remitted on a novel therapy. Neuroblastoma unlike many of the childhood malignancies has grudgingly given ground to modern oncology. Management of those with advanced disease remains a challenge with high mortality despite inroads in improving remission rates with newer therapies including bone marrow transplantation. Krishnadas et al., (doi: 10.1542/peds.2012-0376) writing out of the Hershey Medical Center of Pennsylvania State University, report the novel use of a potent DNA methylation inhibitor, decitabine (DCA), that enhances neuroblastoma’ s expression of an antigen, the cancer testis antigen, that is then used as a target for immunization. The cancer testis antigen is found on few tissues but is present on neuroblastoma. The report documents a remission after treatment in a child resistant to remission despite multiple chemotherapy regimens and bone marrow transplantation. The strategy of enhancing a tumor target to then be attacked by a stimulated immune response may be taking advantage of a neuroblastoma’s known interesting nexus with the immune system. While the child had unremitting bone marrow involvement and not solid tumor persistence the approach is an exciting new approach to an old problem. More cases as well as cases with gross disease need to be studied but the report is one of the most thought provoking reports of the past year.