“The simple answer is, every child matters.”
By Charmaine Gaudet, APR, BHCRI Communications Advisor
Childhood cancer is one of the leading causes of death in children, with more than 800 children under the age of 15 diagnosed in Canada each year. Fortunately, the incidence of childhood cancer is relatively rare, and thanks to medical research, many advances have been made in understanding and treating childhood cancer – so much so that today, more than 80% of children diagnosed with cancer survive.
Researchers associated with the Beatrice Hunter Cancer Research Institute (BHCRI) are studying various aspects of childhood cancer with the goals of improving diagnosis, treatment, and survival rates, while helping us understand the potential damage of cancer treatments to growing bodies. BHCRI advances cancer research through a network of researchers across Atlantic Canada who are dedicated to cancer research excellence, innovation, and training.
Getting an accurate read on cancer
Dr. Daddy Mata-Mbemba is a radiologist at the IWK Health Centre, Assistant Professor in the Department of Diagnostic Radiology at Dalhousie University. He is currently conducting research to improve the imaging diagnosis of neuroblastoma, a type of cancer found in infants and young children, most commonly arising in the adrenal glands.
“Approximately 50-70 new cases of neuroblastoma are diagnosed every year in Canada and in about 50-70% of these cases, the disease has already metastasized – or produced sister cancers elsewhere in the body. This is the highest rate of metastasis for all pediatric cancers, with long-term survival of about 50-60%,” Dr. Mata-Mbemba says. He explains that it is critical to get an accurate read on imaging of the location, size, and extent of the cancer – something that doctors refer to as staging. “For an individual patient, proper staging is of paramount importance for risk assessment and selection of optimal treatment.”
One of the tools that are commonly used by clinicians are IDRFs (Image-Defined Risk Factors) which are tumour imaging features (visible on scans) that predict surgical outcomes and survival for patients with neuroblastoma. He cautions that while IDRFs are a useful tool, much depends on the skills and experience of the pediatric radiologist evaluating these features on CT and MRI scans. He and his team are currently researching ways to improve the visibility and quantification of IDRFs on scans, including investigating whether a drug called Gadolinium is really needed for tumour staging on MRI.
“We can’t do brain tumour research in a bubble.”
Dr. Craig Erker, a pediatric oncologist at the IWK Health Centre and Assistant Professor of Pediatrics at Dalhousie’s Division of Hematology/Oncology, specializes in the area of brain tumours, the number one cause of cancer deaths in children.
However, we have made advancement in care for some brain tumors in children. “The most common tumours are low grade gliomas. We have sub-typed these in terms of their molecular (DNA) signatures, which allows us to target them with specific medicines or ‘precision’ medicines. This has been the major breakthrough in the last decade. This is now becoming the standard of care,” Dr. Erker explains.
Dr. Erker’s work focuses on clinical trials, including serving as site leader on several national studies, assessing how children respond to various treatments. Clinical trials by their nature are collaborative endeavors, and Dr. Erker believes that collaboration is especially important when it comes to childhood brain tumours. “We can’t do brain tumour research in a bubble. There are many different types but because the brain tumour numbers are lower in children than in adults, researchers need to collaborate to share the data and research.” He stresses that this collaborative approach must extend from the bench to the bedside. “Researchers in basic science and clinical areas are working hand in hand. The nature of working in the area of brain tumours means that you’re collaborating with surgeons, physiotherapists, psychologists, etc. The approach to care is a very collaborative one.”
Dr. Erker also believes that conducting clinical trials locally is essential to better treatment and outcomes for children in the Maritimes and Atlantic Canada. “If children don’t have access to clinical trials here, they’d have to go elsewhere, outside the region. Our children here deserve the best and access to more advanced care.”
The goal is a simple blood test
Dr. Sherri Christian is an Associate Professor in the Department of Biochemistry at Memorial University. Dr. Christian specializes in studying leukemia and lymphoma. “The survival rate of children with leukemia is very high, around 80-95%. This success is mainly due to improvements in treatment dosage and timing. However, new therapies that use the patients’ own immune cells, called CAR-T therapy, have also contributed to increases in survival for some types of leukemias. In addition, the development of biological (antibody-based) treatment that specifically targets leukemia cells can be used in some cases,” says Dr. Christian, who adds, “These exciting developments in immunotherapy are a direct result of research performed in the last decade to show how the immune system can be directly harnessed to specifically target and kill leukemia cells.”
However, children whose leukemia or lymphoma returns have a much poorer survival rate compared to at diagnosis, says Dr. Christian. “More research into these cancers is critical to improve survival rates. In my opinion, research into pediatric leukemia, in particular, should be on better monitoring for treatment success. While the current treatment works well for most patients, we need to identify those patients for whom it isn’t working, to allow clinicians to change their treatment. We also need to research the reasons why cancer is harder to treat when it returns.”
Detecting relapses in children with leukemia involves invasive bone marrow or lumbar punctures. Dr. Christian and her team are also working to develop a simple blood test to monitor treatment success. She explains that all cells, and in particular cancer cells, send our small packages of material called extracellular vesicles which enter the bloodstream from cancer cells located anywhere in the body. “These vesicles contain barcodes of DNA or RNA that can link them to the cell of origin. We have found that blood from children with leukemia have a different RNA barcode than blood from children without cancer. So, we are going to start looking to see if this barcode appears in the blood of children whose cancers have returned.”
It’s not just about treatment, it’s about effects, side effects and personalized medicine: Everyone is not the same
Another BHCRI researcher who is interested in treatment related adverse events and disease outcomes is Dr. Ketan Kulkarni, a pediatric hematologist oncologist at the IWK Health Centre and an Associate Professor of Pediatrics, Medicine, Pathology and Pharmacy at Dalhousie University. Dr. Kulkarni studies the adverse events related to cancer and its therapy, including survival outcomes.
“My long-term goal is to integrate the use of advanced technologies to improve the treatment and supportive care of oncology patients,” says Dr. Kulkarni, whose specific focus is on the role of the multi-omics (genome, microbiome, metabolome etc) in treatment-related toxicities and outcomes for childhood cancer patients. He explains that everyone is unique in terms of genetics, drug tolerances and susceptibilities to toxicities – and therefore, each child reacts very differently to treatment. Dr. Kulkarni and his team have demonstrated a strong correlation between the microbiome and treatment toxicity and outcome and the success of their work is advancing the use of microbiome and genomics biomarkers in developing personalized treatments and better patient outcomes.
Like so many other cancer researchers, Dr. Kulkarni collaborates across a broad spectrum of specialties. “It takes everyone working together to advance research and knowledge. I collaborate with basic and translational researchers in pharmacy, pharmacology, gastroenterology, immunology, cancer biology, mathematics and bioinformatics and epidemiology locally, nationally, and internationally,” Dr. Kulkarni says.
Why pursue childhood cancer research?
It takes a special kind of person to devote their life to childhood cancer research. It’s a tough field, where researchers and clinicians see their fair share of heartbreak. But the benefits far outweigh the negatives, researchers insist.
“Saving a child with cancer leads to many years of a high quality of life for that individual in which they can also contribute to society in so many ways. Children have such potential. It is important to give them all the opportunity to reach that potential,” says Dr. Christian.
Dr. Kulkarni puts it equally succinctly, “The simple answer is, every child matters.”
The final word
Only about 7% of research dollars are dedicated to childhood cancer.
“We don’t have enough funds to support clinical research in the Maritimes for pediatric cancer,” says Dr. Erker. “There are not enough funds to support research nurses, laboratory service, or to access all the latest clinical trials. There are not enough funds to maintain a robust research office. We are always asking for help. Funding is necessary for us to advance treatments and quality of life for our children.”
Dr. Kulkarni adds, “Without more advanced and diversified research, cancer will continue to kill some of our children. Our research community needs more funding to support advancements in care and efforts to find more effective treatments.”