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Winning the Battle

Hospitals in the Greater Orlando area are turning the tide when it comes to battling childhood cancers and increasing cure rates.

A mere one percent of all cancers diagnosed are childhood cancers, and although a childhood cancer diagnosis is rare it doesn’t change the fear linked with the disease. No parent wants to hear their child has cancer, but fortunately advancements in cancer treatments are eliminating most childhood cancers leaving an 80 percent success rate for patient survival.

What may have been a broad treatment for all types of cancers 50 years ago has transformed over the decades into a precise treatment, or a combination of treatments, for certain cancer types. There are different ways doctors and researchers are approaching these concepts and standing alongside children in the fight against cancer.

Cancer is the second-leading cause of death in children under 14 according to the American Cancer Society and doctors in the Greater Orlando area are facing those numbers head on by increasing cure rates in certain cancer types. Orlando Family Magazine spoke with doctors in Orlando to learn about the leading advancements in childhood cancer research and treatments.

Using an unlikely source
One virus that can have detrimental effects on unborn babies could be the answer to treating neuroblastoma, a cancer developed in immature nerve cells. Many are familiar with the Zika virus as a disease with severe side effects on newborns and pregnant women, but in reality the effects of the virus are minimal on a fully formed human (child to adult).

Dr. Tamarah Westmoreland is a pediatric general and thoracic surgeon at Nemours Children’s Hospital who is developing a new way to battle neuroblastoma by disregarding normal strategies. After reading an article about the Zika virus’ effect on humans, Westmoreland and a few of her colleagues noticed the neuroblastoma cell line model used in the article was dying as a result of the virus’ side effects.

Their response was to inject the neuroblastoma cell line with the virus.

“What we found in the cell line, derived from patients, is that there were significant cell killings with Zika virus, and also we took it a step further, not just looking at cell killings, but what components may be needed for the virus to perform [those] killings,” Westmoreland says. “And what we found is there’s a specific protein that is sitting on the surface of the cell.”

The protein, CD24, sits on top of these cells making the cell line vulnerable to the virus. In one case, a neuroblastoma cell didn’t have this protein; the doctors engineered the cell so that protein could be introduced to the cells, making it sensitive to the Zika virus. Without CD24, the cell lacks sensitivity and can survive the virus.

Although the treatment is in the very early stages of research, Westmoreland is optimistic with the results. The team is already beginning the next stage of the study by using the science behind their research and translating it to an animal model. She hopes to see a treatment that cures and has little to no side effects.

“One of the advantages of this type of viral therapy is the low side effects. There have been many other viral therapies tried in many different cancers and diseases. One of the problems is the side effects itself from the viral therapy,” Westmoreland says.

Tailoring treatments
Everyone’s body reacts to medicine in different ways. Imagine being able to have a treatment personalized to your genetic biology to react in a positive way. Amy Smith, pediatric neuro-oncologist at Arnold Palmer Hospital for Children says instead of getting a tumor sample and deciphering its classification, it can also be tested for its DNA, RNA and protein signature.

“If a child’s tumor has a very specific gene mutation or a pathway that’s overactive, something that’s identifiable and what we call targetable, meaning there’s a drug that we know about, then that child can be put onto that clinical trial and given that specific drug,” Smith explains.

What’s new in pediatrics is a MATCH study, which is a clinical trial that tests medicine on patients with pediatric cancers. Arnold Palmer Hospital for Children is a part of some clinical research groups that focus on relapsed cancers. By using personalized medicine, doctors taking a biopsy of the refractory tumor can study its new genetic biology to rid the cancer where the initial treatment might not work.

“Once [the cancer is] exposed to certain medications or radiation, it finds little ways to escape. So it may express a different pathway that maybe something else was driving it originally, and now it’s kind of found a new clever way to start growing again,” Smith says.

By tailoring the treatment to each person’s specific cancer, doctors are then able to treat with the correct dose without over treating or under treating patients.

Back to the beginning
As far as current cancer treatments go, Smith says that treatments are pretty maxed out when it comes to radiation and chemotherapy treatment intensity. Doctors and researchers now have to look at treatments from a different angle.

“We can’t just try harder. We have to be smarter,” Smith says. “I think that’s what’s exciting to us is learning more about how our immune system functions and how we might actually use our body’s already natural mechanism by just altering them a little bit to help us.”

Immunotherapy is one way doctors are being smarter in cancer treatments. Dr. Fouad Hajjar, medical director of pediatric hematology and oncology at Florida Hospital for Children, says this immunotherapy treatment, CAR T-cell therapy, is a hallmark of chemotherapy.

“You dig in the immune system and you’re teaching the immune system to recognize those cells that you don’t want to be in the body,” he says. “So you’re re-engineering these T-cells. T-cells are a form of white cells/form of lymphocytes that are present in all of us.”

Re-engineering the cells ultimately kills off the unknown or mutated cells in the body.

Surgery is another form of cancer treatment but surgeons at Florida Hospital are conducting MRIs and CT scans right inside the operating room. Using the intraoperative MRI, the doctor can get a scan while the patient is still under anesthesia to confirm all of the cancer was removed whereas before, the patient and doctor would need to wait up to a few days to see what the scan results were.

“Here at Florida Hospital you can do it right there on the spot and actually that permits the surgeon to say, you know what, before I close I need to get a little piece more, I need to safely go in and take it,” Hajjar adds.

Another way doctors are taking older techniques and transforming them into new technologies is by mixing different treatments rather than focusing on just one to rid the cancer.

“Most of those approaches are done best and come in conjunction with some form of chemotherapy or some form of radiation therapy. We’re finding that mixing those two approaches is actually quite helpful,” Smith says.

Providing a second home
Each of these hospitals not only focuses on the treatment, but also on giving the patient and their family the best possible care. Arnold Palmer Hospital offers a family- and kid-friendly atmosphere as soon as you step through the door. Everyone is very accommodating and takes into account the financial and emotional aspects that take part in the process.

Similarly, Florida Hospital has a team of family and spiritual ambassadors to help the family along at the hospital. Additionally, the charge nurse will come around for a second time during the day to make sure the patient is OK or needs assistance with any issues.

One way Nemours provides a sense of normalcy is having multiple doctors visit the patient in one day. Doing this saves the amount of time the patient spends coming into the hospital, leaving them to go about their week and making other plans.

“I think all of us who are members of the tumor board, which is a specific group of physicians who come together weekly to review patients with cancer and their plan of care, are very cognizant of trying to help these children be able to function and live as normal as they can,” Westmoreland says.

All of these doctors are trying to get to the root of the cancer by not only offering accurate treatments, but by offering a place that the children and families can feel in safe hands.

“I’m blessed to be at a time that we can offer a cure. This is truly a tremendous blessing,” Hajjar says. “We have made tremendous progress and I think that’s important. It’s not a death sentence anymore like it used to be in the past.”

This article originally appeared in Orlando Family Magazine’s September 2018 issue.