In probably one of the first cases in the country, a three and a half year old baby from Mumbai suffering from neuroblastoma was successfully treated with Dinutuximab Immunotherapy at Bai Jerbai Wadia Hospital. Neuroblastoma is a type of cancer that starts in a very early form of nerve cells and occurs in young children. It is the second most common solid tumor in childhood with high-risk neuroblastoma having one of the worst prognoses amongst childhood cancers. Dinutuximab is an immunotherapeutic agent used in combination with other immunomodulating agents to tackle high-risk neuroblastoma in pediatric patients and improve the outcome of this cancer. The little baby is probably the first patient to get this immunotherapy on a compassionate basis. Currently, she is in remission and recovering very well.
Dr. Prashant Hiwarkar, a bone marrow transplant physician at Wadia Hospital informed, “She was presented to B.J. Wadia hospital with non-resolving abdominal pain. An ultrasound showed a mass in her abdomen and a battery of tests later shattered her parents’ world. The baby was diagnosed with metastatic neuroblastoma. It is cancer that starts in a very early form of nerve cells and occurs in young children. It is the second most common solid tumor in childhood with high-risk neuroblastoma having one of the worst prognoses amongst childhood cancers. It is a type of cancer that begins in immature nerve tissue present in the adrenal glands, neck, chest, or spinal cord. The disease is mainly seen in children less than five years, and the symptoms are bone pain and a lump in the abdomen area, neck, or chest. Metastatic neuroblastoma can come back even after aggressive therapy. In India, these children get treated with a conglomerate of therapy involving chemotherapy, surgery, autologous stem cell transplant followed by radiotherapy. Despite all this, only 40 out of 100 children survive long term.”
Dr. Hiwarkar added, “A year after the diagnosis, she was given Dinutuximab, one of the new generations of medications called immunotherapy that we are using at our center to treat patients above 1 year. It is approved by The U.S. Food and Drug Administration (FDA) and used for those patients whose condition hasn’t improved due to the standard cancer treatment. It is becoming the standard approach of therapy for this type of cancer. The drug can be administered as an infusion into a vein for around ten days every 35 days as one course, up to a maximum of 5 courses.”
Dinutuximab is an antibody therapy, a form of immunotherapy. The antibody acts against a sugar-fat molecule present on nearly all neuroblastoma cells (GD2). When the antibody binds to GD2 on the neuroblastoma cells, the cells die in a different way than after chemotherapy or radiotherapy. “Autologous stem cell transplant improves the outcome marginally in this case but the addition of monoclonal antibody-like Dinutuximab beta improves the disease-free survival to 60%,” said Dr. Hiwarkar.
“She is the first patient in the country to receive this drug on a compassionate basis. At Wadia Hospital, we believe in providing world-class services to children from every section of society regardless of their socio-economic background. The hospital has access to another monoclonal antibody (Blinatumomab) used for relapsed or refractory B cell acute lymphoblastic leukemia, a kind of blood cancer. Three children with pediatric leukemia have been treated with Blinatumomab, and all 3 have gone into remission. Two children have successfully undergone a stem cell transplant and one will be transplanted soon,” said Dr. Minnie Bodhanwala, CEO of Wadia Hospital.
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