Neuroblastoma
Zapobieganie i profilaktyka
Neuroblastoma jest najczęstszym pozaczaszkowym guzem litym u dzieci, stanowiąc około 10% zgonów z powodu nowotworów pediatrycznych, głównie diagnozowanym do 2. roku życia. Etiologia opiera się na losowych mutacjach DNA w komórkach pochodzących z grzebienia nerwowego, bez znanych modyfikowalnych czynników ryzyka środowiskowego czy stylu życia. Profilaktyka pierwotna jest ograniczona, jednak suplementacja kwasem foliowym i witaminami w ciąży może zmniejszyć ryzyko neuroblastomy o 30-40%. Karmienie piersią przez 3-13 miesięcy oraz unikanie ekspozycji na pestycydy i dym tytoniowy w ciąży również wykazują potencjalne korzyści. Chemioprewencja z wykorzystaniem difluorometylornityny (DFMO), inhibitora dekarboksylazy ornityny, wykazuje obiecujące wyniki w zapobieganiu nawrotom u pacjentów z neuroblastomą wysokiego ryzyka, z dawką bezpieczną ustaloną na 1500 mg/m² i redukcją ryzyka progresji lub śmierci o 52%. DFMO cechuje się minimalnym profilem działań niepożądanych, głównie wysypkami i łamliwością włosów.
Neuroblastoma – Profilaktyka
Neuroblastoma jest najczęstszym pozaczaszkowym guzem litym u dzieci i odpowiada za około jedną dziesiątą wszystkich zgonów z powodu nowotworów dziecięcych. Choroba ta dotyka głównie dzieci poniżej piątego roku życia, przy czym większość przypadków diagnozowana jest do drugiego roku życia.123 Neuroblastoma powstaje z powodu nieprawidłowo dojrzałych komórek nerwowych wywodzących się z grzebienia nerwowego.45
Możliwość zapobiegania neuroblastomie
Obecnie nie ma znanych sposobów zapobiegania neuroblastomie. Jedyne znane czynniki ryzyka neuroblastomy nie mogą być modyfikowane. Nie ma zidentyfikowanych przyczyn związanych ze stylem życia ani środowiskowych, które przyczyniałyby się do rozwoju neuroblastomy.678
Mutacje DNA, które najprawdopodobniej przyczyniają się do rozwoju neuroblastomy, występują losowo podczas rozwoju płodu i w większości przypadków nie mają konkretnej przyczyny ani czynnika wyzwalającego. Naukowcy nie uważają, że te konkretne mutacje DNA są powodowane czynnikami związanymi ze stylem życia lub środowiskowymi (jak ma to miejsce w przypadku niektórych rodzajów nowotworów u dorosłych).9 Przyczyna neuroblastomy pozostaje nieznana, a badania przesiewowe w kierunku tej choroby nie wykazały wpływu na wyniki leczenia w przypadkach wysokiego ryzyka.10
Potencjalne strategie zapobiegawcze
Mimo że całkowite zapobieganie powstawaniu neuroblastomy nie jest możliwe, pewne działania mogą potencjalnie zmniejszyć ryzyko lub zapobiec nawrotom choroby:
- Suplementacja kwasem foliowym i witaminami – niektóre badania sugerują, że przyjmowanie przez kobiety w ciąży wielowitaminowych suplementów prenatalnych lub kwasu foliowego może obniżyć ryzyko neuroblastomy u ich dzieci, jednak potrzebne są dalsze badania, aby to potwierdzić.1112 Suplementy wielowitaminowe stosowane w czasie ciąży zawierające kwas foliowy, witaminę C, witaminę E, witaminę A, β-karoten i minerały mogą zmniejszyć częstość występowania neuroblastomy nawet o 30-40%.13
- Karmienie piersią – karmienie piersią przez okres od 3 do 13 miesięcy wykazało zmniejszenie rozwoju neuroblastomy poprzez dostarczanie czynników wzrostu nerwów i czynników podobnych do insuliny, które hamują proliferację neuroblastów współczulno-nadnerczowych i promują ich różnicowanie w okresie noworodkowym.14
- Odpowiednia opieka medyczna – zapewnienie właściwej opieki lekarskiej podczas ciąży, aby zapewnić zdrowie płodu.15
- Ograniczenie ekspozycji na szkodliwe czynniki – badania wskazują na związek między neuroblastomą a niektórymi ekspozycjami podczas ciąży, takimi jak stosowanie pestycydów domowych i palenie tytoniu przez matkę, co stanowi dodatkowy powód do doradzania kobietom w ciąży ograniczania tych ekspozycji.16
Chemioprewencja neuroblastomy
Chemioprewencja to wykorzystanie naturalnych, syntetycznych lub biologicznych związków w celu odwrócenia, zapobiegania, opóźniania lub hamowania powstawania, progresji i ewolucji guza.1718 Globalne wysiłki koncentrują się na identyfikacji nowych środków chemoprewencyjnych, zdefiniowaniu ich mechanizmów działania i ocenie korzyści klinicznych.19
Difluorometylornityna (DFMO)
Difluorometylornityna (DFMO) jest szeroko badanym środkiem chemoprewencyjnym w kontroli ewolucji neuroblastomy. DFMO jest nieodwracalnym inhibitorem dekarboksylazy ornityny (ORD), enzymu zaangażowanego w syntezę poliamin w organizmie.2021 Co ważne, DFMO wpływa na sygnalizację LIN28/Let7, a tym samym oddziałuje na linię komórek macierzystych neuroblastomy.2223
DFMO jest poddawany ciągłym badaniom klinicznym w neuroblastomie od czasu pierwszego badania fazy I, które ustaliło bezpieczną dawkę 1500 mg/m² u pacjentów z nawrotem choroby. Badanie fazy II wykazało klinicznie istotną poprawę przeżycia pacjentów z neuroblastomą wysokiego ryzyka po podaniu DFMO po standardowej terapii COG w porównaniu z dopasowanymi kontrolami bez DFMO.2425
Korzyść z leczenia podtrzymującego DFMO w neuroblastomie wskazuje na jego prawdopodobny potencjał do zapobiegania nawrotom u pacjentów z chorobą wysokiego ryzyka. Leczenie DFMO mogłoby nie tylko uzupełniać obecną terapię podtrzymującą, ale także zapewnić długoterminowe korzyści, szczególnie dla dzieci z nawrotową lub pierwotnie oporną chorobą.2627
W 2023 roku Amerykańska Agencja ds. Żywności i Leków (FDA) zatwierdziła eflornithine (DFMO) do zapobiegania nawrotom po standardowym leczeniu neuroblastomy. Jest to pierwszy lek zatwierdzony do zapobiegania nawrotom neuroblastomy u dzieci. Pacjenci w ramieniu badawczym mieli o 52% mniejsze prawdopodobieństwo wystąpienia progresji choroby, nawrotu, wtórnego nowotworu lub śmierci z jakiejkolwiek przyczyny.28
Profil działań niepożądanych DFMO jest minimalny i obejmuje zwykle wysypki skórne i kruchość włosów, co czyni go bezpiecznym lekiem do stosowania w profilaktyce nawrotów.29
Retinoidy
Leczenie kwasem retinowym (RA) w wysokich dawkach może zatrzymać wzrost komórek neuroblastomy i indukować morfologiczne różnicowanie in vitro, a jego włączenie po intensywnej chemioterapii i ABMT (autologicznym przeszczepie szpiku kostnego) poprawia przeżycie wolne od zdarzeń (EFS) w neuroblastomie wysokiego ryzyka.30
Głównymi klinicznymi ograniczeniami retinoidów są ich toksyczność i nierozpuszczalność w wodzie. Pomimo korzyści płynących z 13-cis-RA w poprawie przeżycia pacjentów z neuroblastomą wysokiego ryzyka, rozwój oporności na 13-cis-RA jest również rzeczywistością.31
Dlatego globalne wysiłki koncentrują się na identyfikacji lepszych retinoidów, które prowadzą do mniejszej lub żadnej oporności. W tym kontekście fenretinid/” title=”fenretinid” class=”to-tag” data-termid=”29114″>N-(4-hydroksyfenylo)-retinamid (4-HPR, fenretinid), syntetyczny retinoid, wykazuje zdolność do wywoływania apoptozy i różnicowania, nawet w komórkach neuroblastomy opornych na ATRA i 13-cis-RA.32
Światowa Organizacja Zdrowia (WHO) zaleca retinoidy, a nie witaminę A, jako składnik suplementów wielowitaminowych w celu promowania zdrowia płodu i niemowlęcia oraz zmniejszenia ryzyka neuroblastomy u kobiet w ciąży.33
Nowe metody chemoprewencyjne
Naukowcy odkryli potencjalny sposób leczenia i zapobiegania neuroblastomie u dzieci poprzez poznanie mechanizmu, w którym MYCN kontroluje poziomy poliamin w komórkach nowotworowych, napędzając wzrost i proliferację komórek neuroblastomy. Poprzez połączenie dwóch leków, DFMO i AMXT-1501, z konwencjonalną chemioterapią, zespół badawczy był w stanie znacznie zwiększyć przeżycie u myszy z ustanowionymi guzami neuroblastomy, a także zapobiec tworzeniu się guzów u myszy, które były wolne od guzów, ale genetycznie skłonne do rozwoju choroby.34
Wyniki te pokazują korzyść z łączenia hamowania syntezy poliamin z blokadą transportu poliamin i sugerują, że połączenie AMXT 1501 i DFMO ze standardową chemioterapią może być silną strategią leczenia pacjentów z neuroblastomą wysokiego ryzyka.35
Nutraceutyki w prewencji neuroblastomy
Ostatnie zainteresowanie potencjałem składników odżywczych w zapobieganiu nowotworom i zmniejszaniu złośliwości zaowocowało identyfikacją kilku nutraceutyków, w tym resweratrolu, kurkuminy i molekularnych składników czosnku, które wraz z niektórymi witaminami mogą pomóc w zapobieganiu rozwojowi neuroblastomy.36
Zastosowanie nowatorskich suplementów matczynych zawierających nutraceutyki hamujące neuroblastomę i witaminy ma potencjał nie tylko do zapobiegania rozwojowi neuroblastomy, ale także do wzmacniania spontanicznej regresji neuroblastomy i zmniejszenia wczesnej progresji neuroblastomy podczas wzrostu płodu i wczesnego dzieciństwa.37
Poradnictwo genetyczne
Jeśli w rodzinie występuje historia neuroblastomy, warto porozmawiać z doradcą genetycznym na temat ryzyka rozwoju choroby u dzieci. Ważne jest jednak, aby pamiętać, że rodzinna neuroblastoma występuje bardzo rzadko – tylko w 1-2% przypadków.3839
Wszystkie dzieci z rozpoznaniem neuroblastomy powinny otrzymać poradnictwo genetyczne, aby ustalić, czy konieczne są badania genetyczne.40
Badania naukowe nad prewencją neuroblastomy
Badacze koncentrują się obecnie na kilku strategiach badawczych dotyczących zapobiegania neuroblastomie:
- Badanie czynników w środowisku przedurodzeniowym i okołourodzeniowym, które mogą stanowić prenatalne źródła raka dziecięcego.41
- Lepsze zrozumienie molekularnych podstaw inicjacji raka embrionalnego i modelowanie molekularne inicjacji raka embrionalnego.42
- Charakterystyka nowych małych cząsteczek, które przezwyciężają oporność na śmierć komórkową inicjowaną przez MYCN w komórkach embrionalnych, jako strategie zapobiegania rakowi dziecięcemu.43
- Identyfikacja i celowanie w nowe kofaktory onkogenu MYCN w leczeniu neuroblastomy.44
- Ocena wpływu suplementów diety, hormonów i witamin podczas ciąży na inicjację i rozwój neuroblastomy u potomstwa myszy.45
- Zrozumienie inicjacji i rozwoju neuroblastomy w obecności/nieobecności różnych czynników środowiskowych, przy użyciu linii komórkowych i neurosfer.46
Wnioski
Chociaż obecnie nie ma skutecznych środków zapobiegających neuroblastomie, trwające badania nad chemioprewencją i lepszym zrozumieniem czynników ryzyka dają nadzieję na rozwój strategii profilaktycznych w przyszłości. Skuteczna strategia chemoprewencyjna jest niezbędna, jeśli mamy skutecznie leczyć oporną na terapię postępującą neuroblastomę.47
Mimo że całkowita prewencja powstawania neuroblastomy nie jest możliwa, wtórna i trzeciorzędowa chemioprewencja jest osiągalna i może skutecznie poprawić jakość życia oraz zmniejszyć liczbę zgonów z powodu nowotworów dziecięcych.48
Kolejne rozdziały
Zapraszamy do dalszego czytania naszego leksykonu.
Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.
Materiały źródłowe
- #1 Neuroblastoma – BeatCancerhttps://beatcancer.eu/neuroblastoma/
Given the lack of defined causes, specifically preventable risk factors, Neuroblastoma prevention remains challenging. […] Neuroblastoma primarily affects children under the age of five, with a majority of cases diagnosed by age two.
- #2 Chemoprevention of neuroblastoma: progress and promise beyond uncertaintieshttps://pmc.ncbi.nlm.nih.gov/articles/PMC10798790/
Neuroblastoma is the most common extracranial solid tumor in children and comprises one-tenth of all childhood cancer deaths. […] Despite such intensive treatment, children with neuroblastoma have unacceptable life quality and survival, warranting preventive measures to regulate the cellular functions that orchestrate tumor progression, therapy resistance, metastasis, and tumor relapse/recurrence. […] Globally, active efforts are underway to identify novel chemopreventive agents, define their mechanism(s) of action, and assess their clinical benefit. […] Some chemoprevention strategies (e.g., retinoids, difluoromethylornithine) have already been adopted clinically as part of maintenance phase therapy. […] Thus, global efforts are focused on identifying lead chemopreventive deliverables and developing new and improved chemopreventive strategies for high-risk neuroblastoma.
- #3 Chemoprevention of neuroblastoma: progress and promise beyond uncertaintieshttps://www.oaepublish.com/articles/2394-4722.2022.40
Neuroblastoma is the most common extracranial solid tumor in children and comprises one-tenth of all childhood cancer deaths. […] Despite such intensive treatment, children with neuroblastoma have unacceptable life quality and survival, warranting preventive measures to regulate the cellular functions that orchestrate tumor progression, therapy resistance, metastasis, and tumor relapse/recurrence. […] Globally, active efforts are underway to identify novel chemopreventive agents, define their mechanism(s) of action, and assess their clinical benefit. […] Some chemoprevention strategies (e.g., retinoids, difluoromethylornithine) have already been adopted clinically as part of maintenance phase therapy. […] Thus, global efforts are focused on identifying lead chemopreventive deliverables and developing new and improved chemopreventive strategies for high-risk neuroblastoma.
- #4 Frontiers in Neuroblastoma Treatment | MUSC Health | Charleston SChttps://muschealth.org/health-professionals/progressnotes/2017/fall/features/neuroblastoma-treatment
Neuroblastoma is a solid extracranial cancerous tumor that develops from improperly matured nerve cells. […] The issue is how to improve these outcomes, says Kraveka. One way would be to add a targeted agent during induction to improve response rate this is the front-end approach of the Pediatric Precision Laboratory Advanced Neuroblastoma (PEDS-PLAN) trial (NCT02559778). Another way would be to prevent relapse this is the back-end approach of the PEDS-PLAN and Neuroblastoma Maintenance Therapy (NMTT; NCT02679144) trials. […] Another novel arm of the PEDS-PLAN trial is the addition of difluromethylornithine (DFMO) to maintenance as a strategy to prevent recurrence. […] Preventing relapse is key. After immunotherapy, theres nothing we can do for prevention in standard care, says Kraveka.
- #5 Nutraceutical Preventative and Therapeutic Potential in Neuroblastoma: From Pregnancy to Early Childhoodhttps://www.mdpi.com/2075-1729/12/11/1762
Neuroblastoma (NB) is a highly malignant embryonic extracranial solid tumor that arises from sympathoadrenal neuroblasts of neural crest origin. […] Recent interest in the potential of nutrients to prevent cancer and reduce malignancy has resulted in the identification of several nutraceuticals including resveratrol, curcumin, and molecular components of garlic, which together with certain vitamins may help to prevent NB development. […] Specific NB inhibiting nutraceuticals and vitamins could enhance the preventative influence of maternal nutrition and breast feeding on the development and early progression of NB. […] In this article, we review NB inhibitory nutraceuticals and vitamins, their mechanisms of action and expound their potential as maternal nutritional supplements to reduce NB development and progression during fetal growth and early childhood, whilst at the same time enhancing maternal, fetal, and infant health.
- #6 Can Neuroblastoma Be Prevented? | American Cancer Society | American Cancer Societyhttps://www.cancer.org/cancer/types/neuroblastoma/causes-risks-prevention/prevention.html
The only known risk factors for neuroblastoma cannot be changed. There are no known lifestyle-related or environmental causes of neuroblastomas. […] Some studies suggest that having pregnant women take prenatal multi-vitamins or folic acid might lower the risk of neuroblastoma in their children, but further research is needed to confirm this. […] If there is a history of neuroblastoma in your family, you may want to talk with a genetic counselor about your childrens risks of developing the disease. It is important to remember, though, that familial neuroblastoma is very rare.
- #7 Neuroblastoma Causes, Risk Factors, and Prevention | American Cancer Societyhttps://www.cancer.org/cancer/types/neuroblastoma/causes-risks-prevention.html
The risk of many adult cancers can be reduced with certain lifestyle changes, but at this time there are no known ways to prevent most cancers in children. […] The only known risk factors for neuroblastoma cannot be changed. There are no known lifestyle-related or environmental causes of neuroblastoma at this time.
- #8https://www.acco.org/blog/childhood-neuroblastoma-cancer-causes-risk-factors-and-prevention/
Can Neuroblastoma Be Prevented? Random DNA mutations during fetal development, like the ones that scientists believe may be linked to the development of neuroblastoma, are random events that, in most cases, do not have a specific cause or trigger. Scientists do not believe that these specific DNA mutations are caused by lifestyle or environmental factors (as is the case with some types of adult cancers). Therefore, there is no way to prevent these DNA changes or the development of neuroblastoma. In fact, at this time, there are no known ways to prevent most forms of childhood cancer. […] However, there are no known risk factors linked to lifestyle or environment for most forms of childhood cancer, including neuroblastoma.
- #9https://www.acco.org/blog/childhood-neuroblastoma-cancer-causes-risk-factors-and-prevention/
Can Neuroblastoma Be Prevented? Random DNA mutations during fetal development, like the ones that scientists believe may be linked to the development of neuroblastoma, are random events that, in most cases, do not have a specific cause or trigger. Scientists do not believe that these specific DNA mutations are caused by lifestyle or environmental factors (as is the case with some types of adult cancers). Therefore, there is no way to prevent these DNA changes or the development of neuroblastoma. In fact, at this time, there are no known ways to prevent most forms of childhood cancer. […] However, there are no known risk factors linked to lifestyle or environment for most forms of childhood cancer, including neuroblastoma.
- #10 Pediatric Neuroblastoma Follow-up: Further Outpatient Care, Further Inpatient Care, Inpatient & Outpatient Medicationshttps://emedicine.medscape.com/article/988284-followup
The cause of neuroblastoma is unknown. No specific environmental exposure or risk factors have been identified. […] Currently, no specific recommendations on how to prevent this disease are known. […] Screening for neuroblastoma in an attempt to diagnose high-risk patients earlier in the course of their disease has uncovered many patients with low-risk disease but has not had an impact on outcome in high-risk disease.
- #11 Can Neuroblastoma Be Prevented? | American Cancer Society | American Cancer Societyhttps://www.cancer.org/cancer/types/neuroblastoma/causes-risks-prevention/prevention.html
The only known risk factors for neuroblastoma cannot be changed. There are no known lifestyle-related or environmental causes of neuroblastomas. […] Some studies suggest that having pregnant women take prenatal multi-vitamins or folic acid might lower the risk of neuroblastoma in their children, but further research is needed to confirm this. […] If there is a history of neuroblastoma in your family, you may want to talk with a genetic counselor about your childrens risks of developing the disease. It is important to remember, though, that familial neuroblastoma is very rare.
- #12 Neuroblastoma | Cause | Stages | Diagnosis | Complications | Treatment | Preventionhttps://www.icliniq.com/articles/cancer/neuroblastoma
How to Prevent Neuroblastoma? […] Many adult cancer risks can be prevented by changing their lifestyles, like quitting smoking and diet planning, but many cancers cannot be avoided in children. Neuroblastoma cannot be controlled by any means, but the following methods are helpful: […] Close observation of newborns in a state of family history of neuroblastoma. […] […] Early diagnosis and treatment. […] […] Mothers taking Folic acid and prenatal neuroblastoma can reduce the risk of neuroblastoma in children. […] […] Getting proper care from the doctor during pregnancy to ensure the health of the fetus.
- #13 Nutraceutical Preventative and Therapeutic Potential in Neuroblastoma: From Pregnancy to Early Childhoodhttps://www.mdpi.com/2075-1729/12/11/1762
Multivitamin supplements used in pregnancy contain folic acid, vitamin C, vitamin E, vitamin A, β-carotene, and minerals such as iron, calcium and magnesium, with supplements containing vitamin A and folic acid shown to reduce the incidence of NB by up to 30â40%. […] Therefore, retinoids rather than vitamin A have been recommended by the World Health Organization (WHO) as a component of multivitamin supplements to promote fetal and infant health and decrease the risk of NB in pregnant women. […] This potential would add to the important aims of using maternal nutritional supplements to augment maternal, fetal, and childhood health and may also extend to the prevention of additional fetal pathologies, exemplified by folic acid prevention of neural tube defects. […] In conclusion, the use of novel maternal supplements containing NB inhibitory nutraceuticals and vitamins not only has the potential to prevent NB development, but also to enhance spontaneous NB regression and reduce early NB progression during fetal growth and early childhood.
- #14 Nutraceutical Preventative and Therapeutic Potential in Neuroblastoma: From Pregnancy to Early Childhoodhttps://www.mdpi.com/2075-1729/12/11/1762
Recent interest has also focused on the cancer therapeutic and preventative properties of natural dietary compounds. This has resulted in the identification of several nutraceuticals and vitamins with potent tumor inhibitory activity, suggesting that dietary supplementation with anticancer nutraceuticals and vitamins may not only improve cancer prevention, but also hamper progression. […] Breastfeeding from 3 to 13 months has been shown to reduce NB development by providing nerve and insulin-like growth factors that inhibit sympathoadrenal neuroblast proliferation and promote their differentiation during the neonatal period. […] Considering that an effective cure for advanced stage NB is highly challenging, recent research efforts have also begun to focus on the potential of maternal nutraceutical and vitamin supplements to prevent NB development and impair early NB progression.
- #15 Neuroblastoma | Cause | Stages | Diagnosis | Complications | Treatment | Preventionhttps://www.icliniq.com/articles/cancer/neuroblastoma
How to Prevent Neuroblastoma? […] Many adult cancer risks can be prevented by changing their lifestyles, like quitting smoking and diet planning, but many cancers cannot be avoided in children. Neuroblastoma cannot be controlled by any means, but the following methods are helpful: […] Close observation of newborns in a state of family history of neuroblastoma. […] […] Early diagnosis and treatment. […] […] Mothers taking Folic acid and prenatal neuroblastoma can reduce the risk of neuroblastoma in children. […] […] Getting proper care from the doctor during pregnancy to ensure the health of the fetus.
- #16 Perinatal and environmental risk factors of childhood neuroblastoma РTEL РTh̬ses en lignehttps://theses.hal.science/tel-02475912/
Background: Neuroblastoma is the most common extra-cranial tumor in children. Little is known about the etiology of neuroblastoma. […] This work also adds to the evidence of an association between neuroblastoma and some exposures during pregnancy, such as maternal use of household pesticides and maternal smoking, which are additional reasons why to advise pregnant women to limit these exposures in this period. Further investigations are needed to clarify the role of folic acid supplementation and breastfeeding, given their potential importance in neuroblastoma prevention. […] Conclusion: nos résultats portant sur les associations entre neuroblastome, surcroissance ftale et malformations congnitales supportent lhypothse dun rle des altrations de lembryognse dans la survenue des neuroblastomes de lenfant. Ce travail contribue lvidence en faveur des associations entre neuroblastome et certaines expositions pendant la grossesse, notamment lutilisation domestique de pesticides et le tabagisme maternelle. Nos résultats soulignent limportance des recommandations visant rduire lexposition aux pesticides et le tabagisme maternel pendant la grossesse.
- #17 Chemoprevention of neuroblastoma: progress and promise beyond uncertaintieshttps://pmc.ncbi.nlm.nih.gov/articles/PMC10798790/
It is clear that the rapid reduction in the timeline between successive recurrences is due to the ongoing acquisition of genetic rearrangements in undifferentiated/poorly differentiated cancer. Hence, it is critical to identify new and effective chemoprevention strategies to delay or prevent these acquired events and/or lineage transformation in neuroblastoma cells and thereby defy tumor evolution into progressive disease. […] Chemoprevention is purposing/repurposing the natural, synthetic, or biological compounds to reverse, prevent, delay, or suppress tumor genesis, progression, and evolution. […] Although serious efforts are focused on identifying chemopreventive agents for deadly neuroblastoma, the clinical translation of these agents remains limited, principally attributed to the lack of a comprehensive and compiled understanding of the realized outcomes to date.
- #18 Chemoprevention of neuroblastoma: progress and promise beyond uncertaintieshttps://www.oaepublish.com/articles/2394-4722.2022.40
Chemoprevention is purposing/repurposing the natural, synthetic, or biological compounds to reverse, prevent, delay, or suppress tumor genesis, progression, and evolution. […] The modes of action for blocking agents include regulation of metabolic activation, blocking DNA damage, hypermethylation of tumor suppressors, and inhibition of histone deacetylases. […] The chemopreventive agent difluoromethylornithine (DFMO) has been widely studied in neuroblastoma evolution control. […] Importantly, DFMO targets LIN28/Let7 signaling and thereby affects the neuroblastoma cancer stem cell lineage. […] A Phase II study demonstrated clinically significant improvement in the survival of high-risk neuroblastoma patients with DFMO administration after standard COG therapy when compared with the no-DFMO matched controls.
- #19 Chemoprevention of neuroblastoma: progress and promise beyond uncertaintieshttps://pmc.ncbi.nlm.nih.gov/articles/PMC10798790/
Neuroblastoma is the most common extracranial solid tumor in children and comprises one-tenth of all childhood cancer deaths. […] Despite such intensive treatment, children with neuroblastoma have unacceptable life quality and survival, warranting preventive measures to regulate the cellular functions that orchestrate tumor progression, therapy resistance, metastasis, and tumor relapse/recurrence. […] Globally, active efforts are underway to identify novel chemopreventive agents, define their mechanism(s) of action, and assess their clinical benefit. […] Some chemoprevention strategies (e.g., retinoids, difluoromethylornithine) have already been adopted clinically as part of maintenance phase therapy. […] Thus, global efforts are focused on identifying lead chemopreventive deliverables and developing new and improved chemopreventive strategies for high-risk neuroblastoma.
- #20 Chemoprevention of neuroblastoma: progress and promise beyond uncertaintieshttps://pmc.ncbi.nlm.nih.gov/articles/PMC10798790/
Here we review the drugs investigated for chemoprevention of neuroblastoma, their strategies, the mechanism(s) of action, and outcomes. This review is focused on the chemopreventive agents that reduce, inhibit, or delay neuroblastoma progression. […] The chemopreventive agent difluoromethylornithine (DFMO) has been widely studied in neuroblastoma evolution control. […] Importantly, DFMO targets LIN28/Let7 signaling and thereby affects the neuroblastoma cancer stem cell lineage. […] DFMO has been under continuous clinical investigation for neuroblastoma since the first Phase 1 study that established a safe dose of 1,500 mg/m2 in relapsed patients. […] A Phase II study demonstrated clinically significant improvement in the survival of high-risk neuroblastoma patients with DFMO administration after standard COG therapy when compared with the no-DFMO matched controls.
- #21 DFMO Under Study as Maintenance Therapy for High-Risk Neuroblastoma in Children, Young Adultshttps://consultqd.clevelandclinic.org/dfmo-under-study-as-maintenance-therapy-for-high-risk-neuroblastoma-in-children-young-adults
DFMO is an irreversible inhibitor of ornithine decarboxylase [ORD], an enzyme involved in the synthesis of polyamines in the body, explains Dr. Zahler. […] The studys purpose is to assess the utility of DFMO as a single-agent prevention strategy for neuroblastoma recurrence. […] Dr. Zahler says the preliminary results are promising and she is optimistic about DFMOs effectiveness in the maintenance setting. […] Additionally, its side effect profile is minimal and usually includes skin rashes and brittle hair. […] We are well on our way there and are hopeful that DFMO may get approved sooner than the standard 12 years that approvals typically take, she says.
- #22 Chemoprevention of neuroblastoma: progress and promise beyond uncertaintieshttps://pmc.ncbi.nlm.nih.gov/articles/PMC10798790/
Here we review the drugs investigated for chemoprevention of neuroblastoma, their strategies, the mechanism(s) of action, and outcomes. This review is focused on the chemopreventive agents that reduce, inhibit, or delay neuroblastoma progression. […] The chemopreventive agent difluoromethylornithine (DFMO) has been widely studied in neuroblastoma evolution control. […] Importantly, DFMO targets LIN28/Let7 signaling and thereby affects the neuroblastoma cancer stem cell lineage. […] DFMO has been under continuous clinical investigation for neuroblastoma since the first Phase 1 study that established a safe dose of 1,500 mg/m2 in relapsed patients. […] A Phase II study demonstrated clinically significant improvement in the survival of high-risk neuroblastoma patients with DFMO administration after standard COG therapy when compared with the no-DFMO matched controls.
- #23 Chemoprevention of neuroblastoma: progress and promise beyond uncertaintieshttps://www.oaepublish.com/articles/2394-4722.2022.40
Chemoprevention is purposing/repurposing the natural, synthetic, or biological compounds to reverse, prevent, delay, or suppress tumor genesis, progression, and evolution. […] The modes of action for blocking agents include regulation of metabolic activation, blocking DNA damage, hypermethylation of tumor suppressors, and inhibition of histone deacetylases. […] The chemopreventive agent difluoromethylornithine (DFMO) has been widely studied in neuroblastoma evolution control. […] Importantly, DFMO targets LIN28/Let7 signaling and thereby affects the neuroblastoma cancer stem cell lineage. […] A Phase II study demonstrated clinically significant improvement in the survival of high-risk neuroblastoma patients with DFMO administration after standard COG therapy when compared with the no-DFMO matched controls.
- #24 Chemoprevention of neuroblastoma: progress and promise beyond uncertaintieshttps://pmc.ncbi.nlm.nih.gov/articles/PMC10798790/
Here we review the drugs investigated for chemoprevention of neuroblastoma, their strategies, the mechanism(s) of action, and outcomes. This review is focused on the chemopreventive agents that reduce, inhibit, or delay neuroblastoma progression. […] The chemopreventive agent difluoromethylornithine (DFMO) has been widely studied in neuroblastoma evolution control. […] Importantly, DFMO targets LIN28/Let7 signaling and thereby affects the neuroblastoma cancer stem cell lineage. […] DFMO has been under continuous clinical investigation for neuroblastoma since the first Phase 1 study that established a safe dose of 1,500 mg/m2 in relapsed patients. […] A Phase II study demonstrated clinically significant improvement in the survival of high-risk neuroblastoma patients with DFMO administration after standard COG therapy when compared with the no-DFMO matched controls.
- #25 Chemoprevention of neuroblastoma: progress and promise beyond uncertaintieshttps://www.oaepublish.com/articles/2394-4722.2022.40
Chemoprevention is purposing/repurposing the natural, synthetic, or biological compounds to reverse, prevent, delay, or suppress tumor genesis, progression, and evolution. […] The modes of action for blocking agents include regulation of metabolic activation, blocking DNA damage, hypermethylation of tumor suppressors, and inhibition of histone deacetylases. […] The chemopreventive agent difluoromethylornithine (DFMO) has been widely studied in neuroblastoma evolution control. […] Importantly, DFMO targets LIN28/Let7 signaling and thereby affects the neuroblastoma cancer stem cell lineage. […] A Phase II study demonstrated clinically significant improvement in the survival of high-risk neuroblastoma patients with DFMO administration after standard COG therapy when compared with the no-DFMO matched controls.
- #26 Chemoprevention of neuroblastoma: progress and promise beyond uncertaintieshttps://pmc.ncbi.nlm.nih.gov/articles/PMC10798790/
Such a benefit of EFS maintenance with DFMO in neuroblastoma indicates its probable potential to prevent relapse in patients with high-risk disease. […] With these promising and measurable outcomes, DFMO treatment could not only complement current maintenance therapy but also provide long-term benefits, particularly for children presenting with relapsed or primary refractory disease. […] Overall, RA treatment in high doses can arrest neuroblastoma cell growth and induce morphological differentiation in vitro, and its inclusion after intensive chemotherapy and ABMT improves EFS in high-risk neuroblastoma. […] The major clinical limitations of retinoids are their toxicity and water insolubility. […] Despite the benefits of 13-cis-RA in improving the survival of high-risk neuroblastoma patients, the development of 13-cis-RA resistance is also a reality.
- #27 Chemoprevention of neuroblastoma: progress and promise beyond uncertaintieshttps://www.oaepublish.com/articles/2394-4722.2022.40
With these promising and measurable outcomes, DFMO treatment could not only complement current maintenance therapy but also provide long-term benefits, particularly for children presenting with relapsed or primary refractory disease. […] Although complete prevention of neuroblastoma genesis is not feasible, secondary and tertiary chemoprevention is achievable and could effectively improve the quality of life and reduce childhood cancer deaths. […] Identifying an effective chemopreventive strategy is critical for high-risk neuroblastoma patients, particularly those presenting with aggressive metastatic disease and/or with therapy defying progressive disease.
- #28 New Drug Aims to Prevent Neuroblastoma Relapse | AACRhttps://www.aacr.org/patients-caregivers/progress-against-cancer/new-drug-aims-to-prevent-neuroblastoma-relapse/
The FDA has approved eflornithine to prevent relapse after standard-of-care therapy for neuroblastoma. […] It is also the first treatment approved for the prevention of neuroblastoma relapse in children. […] Patients in the investigational arm were 52% less likely to experience disease progression, relapse, secondary cancer, or death due to any cause.
- #29 DFMO Under Study as Maintenance Therapy for High-Risk Neuroblastoma in Children, Young Adultshttps://consultqd.clevelandclinic.org/dfmo-under-study-as-maintenance-therapy-for-high-risk-neuroblastoma-in-children-young-adults
DFMO is an irreversible inhibitor of ornithine decarboxylase [ORD], an enzyme involved in the synthesis of polyamines in the body, explains Dr. Zahler. […] The studys purpose is to assess the utility of DFMO as a single-agent prevention strategy for neuroblastoma recurrence. […] Dr. Zahler says the preliminary results are promising and she is optimistic about DFMOs effectiveness in the maintenance setting. […] Additionally, its side effect profile is minimal and usually includes skin rashes and brittle hair. […] We are well on our way there and are hopeful that DFMO may get approved sooner than the standard 12 years that approvals typically take, she says.
- #30 Chemoprevention of neuroblastoma: progress and promise beyond uncertaintieshttps://pmc.ncbi.nlm.nih.gov/articles/PMC10798790/
Such a benefit of EFS maintenance with DFMO in neuroblastoma indicates its probable potential to prevent relapse in patients with high-risk disease. […] With these promising and measurable outcomes, DFMO treatment could not only complement current maintenance therapy but also provide long-term benefits, particularly for children presenting with relapsed or primary refractory disease. […] Overall, RA treatment in high doses can arrest neuroblastoma cell growth and induce morphological differentiation in vitro, and its inclusion after intensive chemotherapy and ABMT improves EFS in high-risk neuroblastoma. […] The major clinical limitations of retinoids are their toxicity and water insolubility. […] Despite the benefits of 13-cis-RA in improving the survival of high-risk neuroblastoma patients, the development of 13-cis-RA resistance is also a reality.
- #31 Chemoprevention of neuroblastoma: progress and promise beyond uncertaintieshttps://pmc.ncbi.nlm.nih.gov/articles/PMC10798790/
Such a benefit of EFS maintenance with DFMO in neuroblastoma indicates its probable potential to prevent relapse in patients with high-risk disease. […] With these promising and measurable outcomes, DFMO treatment could not only complement current maintenance therapy but also provide long-term benefits, particularly for children presenting with relapsed or primary refractory disease. […] Overall, RA treatment in high doses can arrest neuroblastoma cell growth and induce morphological differentiation in vitro, and its inclusion after intensive chemotherapy and ABMT improves EFS in high-risk neuroblastoma. […] The major clinical limitations of retinoids are their toxicity and water insolubility. […] Despite the benefits of 13-cis-RA in improving the survival of high-risk neuroblastoma patients, the development of 13-cis-RA resistance is also a reality.
- #32 Chemoprevention of neuroblastoma: progress and promise beyond uncertaintieshttps://pmc.ncbi.nlm.nih.gov/articles/PMC10798790/
Thus, global efforts focus on identifying better retinoids that lead to less or no resistance. […] In this regard, N-(4-hydroxyphenyl)-retinamide (4-HPR, fenretinide), a synthetic retinoid, has been shown to cause apoptosis and differentiation, even in ATRA- and 13-cis-RA-resistant neuroblastoma cells. […] In conclusion, an effective chemopreventive strategy is a requisite if we are to successfully treat therapy-defying progressive neuroblastoma.
- #33 Nutraceutical Preventative and Therapeutic Potential in Neuroblastoma: From Pregnancy to Early Childhoodhttps://www.mdpi.com/2075-1729/12/11/1762
Multivitamin supplements used in pregnancy contain folic acid, vitamin C, vitamin E, vitamin A, β-carotene, and minerals such as iron, calcium and magnesium, with supplements containing vitamin A and folic acid shown to reduce the incidence of NB by up to 30â40%. […] Therefore, retinoids rather than vitamin A have been recommended by the World Health Organization (WHO) as a component of multivitamin supplements to promote fetal and infant health and decrease the risk of NB in pregnant women. […] This potential would add to the important aims of using maternal nutritional supplements to augment maternal, fetal, and childhood health and may also extend to the prevention of additional fetal pathologies, exemplified by folic acid prevention of neural tube defects. […] In conclusion, the use of novel maternal supplements containing NB inhibitory nutraceuticals and vitamins not only has the potential to prevent NB development, but also to enhance spontaneous NB regression and reduce early NB progression during fetal growth and early childhood.
- #34 Scientists discover potential way to treat and prevent neuroblastoma in children – ecancerhttps://ecancer.org/en/news/15388-scientists-discover-potential-way-to-treat-and-prevent-neuroblastoma-in-children
Scientists discover potential way to treat and prevent neuroblastoma in children. […] The discovery of this link – by which MYCN controls polyamine levels in cancer cells, driving the growth and proliferation of the neuroblastoma cells is meaningful as scientists have a potential therapeutic „way in” to disrupting cancer cell growth for the first time. […] By combining these two drugs, DFMO and AMXT-1501, with conventional chemotherapy, the research team were able to significantly increase survival in mice with established neuroblastoma tumours, as well as prevent tumour formation in mice who were tumour-free but genetically prone to developing the disease. […] „This exciting new treatment approach warrants clinical investigation in children with MYCN-driven high-risk neuroblastoma and potentially other cancers as well,” said Haber.
- #35 Scientists discover potential way to treat and prevent neuroblastoma in children – ecancerhttps://ecancer.org/en/news/15388-scientists-discover-potential-way-to-treat-and-prevent-neuroblastoma-in-children
„These findings demonstrate the benefit of combining inhibition of polyamine synthesis with blockade of polyamine transport and suggest that combining AMXT 1501 and DFMO with standard chemotherapy may be a potent treatment strategy for high-risk neuroblastoma patients,” Burns said. […] „We have already shown in our current clinical trial that targeting polyamines with one drug (DFMO) can be safely achieved in combination with chemotherapy. By combining two drugs targeting the same pathway we have the potential to further improve the anti-cancer effect for these children.”
- #36 Nutraceutical Preventative and Therapeutic Potential in Neuroblastoma: From Pregnancy to Early Childhoodhttps://www.mdpi.com/2075-1729/12/11/1762
Neuroblastoma (NB) is a highly malignant embryonic extracranial solid tumor that arises from sympathoadrenal neuroblasts of neural crest origin. […] Recent interest in the potential of nutrients to prevent cancer and reduce malignancy has resulted in the identification of several nutraceuticals including resveratrol, curcumin, and molecular components of garlic, which together with certain vitamins may help to prevent NB development. […] Specific NB inhibiting nutraceuticals and vitamins could enhance the preventative influence of maternal nutrition and breast feeding on the development and early progression of NB. […] In this article, we review NB inhibitory nutraceuticals and vitamins, their mechanisms of action and expound their potential as maternal nutritional supplements to reduce NB development and progression during fetal growth and early childhood, whilst at the same time enhancing maternal, fetal, and infant health.
- #37 Nutraceutical Preventative and Therapeutic Potential in Neuroblastoma: From Pregnancy to Early Childhoodhttps://www.mdpi.com/2075-1729/12/11/1762
Multivitamin supplements used in pregnancy contain folic acid, vitamin C, vitamin E, vitamin A, β-carotene, and minerals such as iron, calcium and magnesium, with supplements containing vitamin A and folic acid shown to reduce the incidence of NB by up to 30â40%. […] Therefore, retinoids rather than vitamin A have been recommended by the World Health Organization (WHO) as a component of multivitamin supplements to promote fetal and infant health and decrease the risk of NB in pregnant women. […] This potential would add to the important aims of using maternal nutritional supplements to augment maternal, fetal, and childhood health and may also extend to the prevention of additional fetal pathologies, exemplified by folic acid prevention of neural tube defects. […] In conclusion, the use of novel maternal supplements containing NB inhibitory nutraceuticals and vitamins not only has the potential to prevent NB development, but also to enhance spontaneous NB regression and reduce early NB progression during fetal growth and early childhood.
- #38 Can Neuroblastoma Be Prevented? | American Cancer Society | American Cancer Societyhttps://www.cancer.org/cancer/types/neuroblastoma/causes-risks-prevention/prevention.html
The only known risk factors for neuroblastoma cannot be changed. There are no known lifestyle-related or environmental causes of neuroblastomas. […] Some studies suggest that having pregnant women take prenatal multi-vitamins or folic acid might lower the risk of neuroblastoma in their children, but further research is needed to confirm this. […] If there is a history of neuroblastoma in your family, you may want to talk with a genetic counselor about your childrens risks of developing the disease. It is important to remember, though, that familial neuroblastoma is very rare.
- #39 Neuroblastoma: What is It, Stages, Causes, Symptoms, Treatmentshttps://my.clevelandclinic.org/health/diseases/14390-neuroblastoma
It isnt possible to prevent neuroblastoma. […] All children diagnosed with neuroblastoma should receive genetic counseling to see if genetic testing is needed. […] However, it is important to remember that the inherited form of neuroblastoma is very rare only 1% to 2% of cases.
- #40 Neuroblastoma: What is It, Stages, Causes, Symptoms, Treatmentshttps://my.clevelandclinic.org/health/diseases/14390-neuroblastoma
It isnt possible to prevent neuroblastoma. […] All children diagnosed with neuroblastoma should receive genetic counseling to see if genetic testing is needed. […] However, it is important to remember that the inherited form of neuroblastoma is very rare only 1% to 2% of cases.
- #41 Embryonal Cancer Therapy & Prevention | Childrenâs Cancer Institutehttps://www.ccia.org.au/about-the-institute/our-research/gene-regulation-in-cancer/embryonal-cancer-therapy-and-prevention
Very little is known about the factors that lead to the development of cancer in children. […] Our overall strategy is to dissect the mechanisms of cancer initiation and progression and to use this information to develop more effective treatments and prevention strategies for childhood cancer. […] Study the factors in the pre and peri-natal environment which may represent the prenatal origins of child cancer. […] Better understand the molecular basis of embryonal cancer initiation and molecular modelling of embryonal cancer initiation. […] Characterise novel small molecules that overcome MYCN-initiated cell-death resistance in embryonic cells, as childhood cancer prevention strategies. […] Identify and target novel onco-factors of the MYCN oncogene for neuroblastoma treatment. […] Neuroblastoma arises due to defects in sympathetic neuron differentiation during foetal development.
- #42 Embryonal Cancer Therapy & Prevention | Childrenâs Cancer Institutehttps://www.ccia.org.au/about-the-institute/our-research/gene-regulation-in-cancer/embryonal-cancer-therapy-and-prevention
Very little is known about the factors that lead to the development of cancer in children. […] Our overall strategy is to dissect the mechanisms of cancer initiation and progression and to use this information to develop more effective treatments and prevention strategies for childhood cancer. […] Study the factors in the pre and peri-natal environment which may represent the prenatal origins of child cancer. […] Better understand the molecular basis of embryonal cancer initiation and molecular modelling of embryonal cancer initiation. […] Characterise novel small molecules that overcome MYCN-initiated cell-death resistance in embryonic cells, as childhood cancer prevention strategies. […] Identify and target novel onco-factors of the MYCN oncogene for neuroblastoma treatment. […] Neuroblastoma arises due to defects in sympathetic neuron differentiation during foetal development.
- #43 Embryonal Cancer Therapy & Prevention | Childrenâs Cancer Institutehttps://www.ccia.org.au/about-the-institute/our-research/gene-regulation-in-cancer/embryonal-cancer-therapy-and-prevention
Very little is known about the factors that lead to the development of cancer in children. […] Our overall strategy is to dissect the mechanisms of cancer initiation and progression and to use this information to develop more effective treatments and prevention strategies for childhood cancer. […] Study the factors in the pre and peri-natal environment which may represent the prenatal origins of child cancer. […] Better understand the molecular basis of embryonal cancer initiation and molecular modelling of embryonal cancer initiation. […] Characterise novel small molecules that overcome MYCN-initiated cell-death resistance in embryonic cells, as childhood cancer prevention strategies. […] Identify and target novel onco-factors of the MYCN oncogene for neuroblastoma treatment. […] Neuroblastoma arises due to defects in sympathetic neuron differentiation during foetal development.
- #44 Embryonal Cancer Therapy & Prevention | Childrenâs Cancer Institutehttps://www.ccia.org.au/about-the-institute/our-research/gene-regulation-in-cancer/embryonal-cancer-therapy-and-prevention
Very little is known about the factors that lead to the development of cancer in children. […] Our overall strategy is to dissect the mechanisms of cancer initiation and progression and to use this information to develop more effective treatments and prevention strategies for childhood cancer. […] Study the factors in the pre and peri-natal environment which may represent the prenatal origins of child cancer. […] Better understand the molecular basis of embryonal cancer initiation and molecular modelling of embryonal cancer initiation. […] Characterise novel small molecules that overcome MYCN-initiated cell-death resistance in embryonic cells, as childhood cancer prevention strategies. […] Identify and target novel onco-factors of the MYCN oncogene for neuroblastoma treatment. […] Neuroblastoma arises due to defects in sympathetic neuron differentiation during foetal development.
- #45 Embryonal Cancer Therapy & Prevention | Childrenâs Cancer Institutehttps://www.ccia.org.au/about-the-institute/our-research/gene-regulation-in-cancer/embryonal-cancer-therapy-and-prevention
Recent findings from our lab and those of our collaborators suggest that environmental factors such as high birth weight, certain maternal dietary supplements, and nitrous oxide exposure during neonatal age, are associated with an increased occurrence of childhood cancer. […] To evaluate impacts of dietary supplements, hormones and vitamins during pregnancy on initiation and development of neuroblastoma in mice offspring. […] To understand initiation and development of neuroblastoma in the presence/absence of different environmental factors, using cell lines and neurospheres.
- #46 Embryonal Cancer Therapy & Prevention | Childrenâs Cancer Institutehttps://www.ccia.org.au/about-the-institute/our-research/gene-regulation-in-cancer/embryonal-cancer-therapy-and-prevention
Recent findings from our lab and those of our collaborators suggest that environmental factors such as high birth weight, certain maternal dietary supplements, and nitrous oxide exposure during neonatal age, are associated with an increased occurrence of childhood cancer. […] To evaluate impacts of dietary supplements, hormones and vitamins during pregnancy on initiation and development of neuroblastoma in mice offspring. […] To understand initiation and development of neuroblastoma in the presence/absence of different environmental factors, using cell lines and neurospheres.
- #47 Chemoprevention of neuroblastoma: progress and promise beyond uncertaintieshttps://pmc.ncbi.nlm.nih.gov/articles/PMC10798790/
Thus, global efforts focus on identifying better retinoids that lead to less or no resistance. […] In this regard, N-(4-hydroxyphenyl)-retinamide (4-HPR, fenretinide), a synthetic retinoid, has been shown to cause apoptosis and differentiation, even in ATRA- and 13-cis-RA-resistant neuroblastoma cells. […] In conclusion, an effective chemopreventive strategy is a requisite if we are to successfully treat therapy-defying progressive neuroblastoma.
- #48 Chemoprevention of neuroblastoma: progress and promise beyond uncertaintieshttps://www.oaepublish.com/articles/2394-4722.2022.40
With these promising and measurable outcomes, DFMO treatment could not only complement current maintenance therapy but also provide long-term benefits, particularly for children presenting with relapsed or primary refractory disease. […] Although complete prevention of neuroblastoma genesis is not feasible, secondary and tertiary chemoprevention is achievable and could effectively improve the quality of life and reduce childhood cancer deaths. […] Identifying an effective chemopreventive strategy is critical for high-risk neuroblastoma patients, particularly those presenting with aggressive metastatic disease and/or with therapy defying progressive disease.
Zobacz więcej
eflornithine onkogen MYCN poradnictwo genetyczne guz lity pozaczaszkowy kurkumina resweratrol przeżycie wolne od zdarzeń czynnik wzrostu nerwów chemioprewencja difluorometylornityna komórki macierzyste neuroblastoma dekarboksylaza ornityny karmienie piersią kwas foliowy leczenie podtrzymujące neuroblast kwas retinowy grzebień nerwowy