Improving childhood cancer treatment
A careful, individually tailored reduction in the number of drugs being used to treat a child with leukaemia or lymphoma to the lowest level possible that still maintains the effectiveness of the treatment, will improve that child's chances of surviving cancer.
In 2015 Professor Smith – a native Dubliner who worked for years in the UK - was awarded an honorary CBE from Queen Elizabeth II in recognition of his work on cancer in children and adolescents for the past 25 years.
Professor Smith said that one huge factor in improving survival rates for childhood leukaemia and lymphoma in Ireland has been the fact that every child diagnosed with these cancers at OLCHC has access to a clinical trial. He, and his colleagues at OLCHC, are huge proponents of clinical trials – he believes they have brought about a revolution, driving the survival rates of children with leukaemia up to 80-85% – a massive jump up from the 1980s. This is considered by many to be the single biggest achievement in cancer treatment in the twentieth century.
However, the sad truth is that of the children diagnosed with leukaemia in Ireland each year, some of these will die. ‘To further improve survival rates, and the quality of life of those who survive,’ said Professor Smith, ‘the goal must be to reduce children's exposure to toxic drugs in chemotherapy to the lowest level that still provides effective treatment for each child’.
A number of the trials at OLCHC are specifically aimed at reducing the toxicity and side effects of cancer treatment.
Children with leukaemia today are treated with a regimen of up to 16 drugs. It is highly likely that for some of these children, the number of drugs can be cut significantly – the difficulty is identifying the best regime for each child.
The team’s current focus is on identifying which children can benefit from a reduction in their drug load, yet maintain high survival rates. The need for a more patient, and leukaemia specific approach has led to identification of prognostic risk tests that allow only high risk patients to be treated aggressively, with less toxic therapy reserved for those patients at lower risk of relapse.
There remain many unmet needs in childhood cancer. The outcome for older teenagers and young adults with leukaemia is not as good as for young children. This is a particular focus area for Professor Smith.
‘The survival rate for some other childhood cancers, such as certain brain cancers and stage-four neuroblastoma, hasn't shifted upwards like the other cancers, and they are proving hard nuts to crack,’ said Prof Smith. ‘However, as we achieve a greater understanding of the biology of these cancers through research, this will change in the coming years’.
How this clinical research helps:
Treatments are now being better tailored so that only children with high risk of relapse receive the most aggressive treatment with less toxic therapy offered to those at lower risk.