In February, Children's of Alabama was accepted into the Pacific Pediatric Neuro-Oncology Consortium (PNOC), a collection of hospitals focusing on clinical trials for children with malignant brain tumors. The membership joins Children's with 27 other top pediatric hospitals from the United States, Canada, Australia and Europe, accessing 225 pediatric brain tumor specialists.
In pediatric oncology, over 95 percent of the time, research institutions need to work in collaboration with each other to be able to run clinical trials. "Cancer is not very common in pediatrics," says neuro-oncologist Girish Dhall, MD, director of the Division of Pediatric Hematology, Oncology and Blood & Marrow Transplantation at Children's and UAB. "Therefore, any single institution cannot run clinical trials by themselves, because we don't have the numbers."
But PNOC opens an even more exclusive path to cutting-edge and state-of-the-art clinical trials on pediatric brain tumors. "PNOC is different because its major mission is on personalized therapy trials," Dhall says. "Their main focus is clinical trials specific to a patient's tumor."
Children's was selected to be a part of PNOC due to the transformative work ongoing at its Alabama Center for Childhood Cancer and Blood Disorders, where more than 1,500 young patients seek treatment each year.
Children's belongs to several clinical trial consortia, including the Children's Oncology Group (COG), funded by the National Cancer Institute with almost 200 children's hospitals in the country. However, COG mostly runs clinical trials for newly diagnosed patients.
The customized approach at PNOC to the biology of each individual's tumor, however, creates opportunities for clinical trials rarely found for children. "Unfortunately, we don't have too many options for the unlucky children who have the disease return," Dhall says. "The biggest difference is PNOC really believes in treating each tumor differently rather than putting all the tumors in one bucket and doing a clinical trial." This enables trials to focus on testing new therapies derived to maximize a treatment's effectiveness for that child.
Now as part of PNOC, the hospital saves children and their families the complexity and stress of needing to travel outside Alabama to access these trials. "This allows us to present treatment options for patients who have really difficult diseases," Dhall says. "They can stay at home."
Dhall was one of the founding members of the unique consortium. "When I was in Los Angeles around 2012, we started off as only Pacific Coast institutions--Seattle, Portland, San Francisco, LA and San Diego." Since then, PNOC has slowly expanded across the country and beyond U.S. borders.
Unlike other consortia, PNOC's clinical trial portfolio includes neurosurgery trials with techniques such as convection-enhanced delivery, fluorescent agents, and advanced imaging compounds. "Traditionally we use chemotherapy or radiation therapy for these cancers, but both just kill rapidly dividing cells and don't discriminate between cells inside the cancer and cells that might normally be rapidly dividing inside the body," Dhall says.
The quest to replace broadly applied treatment therapies, like radiation, with targeted ones is growing rapidly. "It is not just brain tumors, but the field of oncology is trying to understand at a molecular level what makes tumors grow, so can we target just the tumor itself," Dhall says. Beyond medications and biological agents, immuno-oncology researchers have begun finding ways to harness the body's own immune system to specifically attack cancer cells.
"There are a lot of clinical trials through PNOC on these approaches," Dhall says. "Currently, PNOC has 26 clinical trials underway. The investigational agents being researched are not new chemotherapy drugs anymore. They're new biologic drugs or immunotherapy trials that are targeting the tumor itself."
But these new approaches have a way to go before becoming the primary treatment in oncology. "We're not there yet. We're still using chemotherapy and radiation," Dhall says. "But it's where the field is going, and needs to go."
To learn about any open clinical trials in pediatric brain cancer, contact either Bridget Tate btate@peds.uab.edu or Dhall at gdhall@peds.uab.edu