Atypical teratoid rhabdoid tumor future or investigational therapies
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Future or Investigational Therapies
Chromatin Re-modeling Agents
This protocol is still in pre-clinical evaluation. HDAC inhibitors are a new class of anticancer agents targeted directly at chromatin remodeling. These agents have been used in acute promyelocytic leukemia and have been found to affect the HDAC-mediated transcriptional repression. There is too little understanding of the INI1 deficiency to predict whether HDAC inhibitors will be effective against AT/RTs. There are some laboratory results that indicate it is effective against certain AT/RT cell lines.[1]
Current research is focusing on using chemotherapy protocols that are effective against rhabdomyosarcoma in combination with surgery and radiation therapy.
Research Directions
Atypical teratoid rhabdoid tumor is rare and no therapy has been proven to deliver long-term survival, nor is there a set of standard protocols. Thus, most children with AT/RT are enrolled in clinical trials to attempt to find an effective cure. A clinical trial is not a treatment standard; it is research. Some clinical trials compare an experimental treatment to a standard treatment, but only if such a standard treatment exists.
- Pilot Study of Systemic and Intrathecal Chemotherapy followed by Conformal Radiation for Infants with Embryonal Intracranial Central Nervous System Tumors, A Pediatric Brain Tumor Consortium Protocol. This study (PBTC-001) is run out of the nine institutions associated with the Pediatric Brain Tumor consortium and uses combined modalities including intrathecal mafosfamide, systemic chemotherapy (vincristine, cyclophosphamide, cisplatinum and oral etoposide) and possibly the use of craniospinal or conformal radiation.
- Head Start Chemotherapy Protocol. This chemotherapy protocol is for children <10 years old with newly diagnosed high grade primary brain tumors with intent to eliminate irradiation and shorten the treatment time to 6 months. The therapy consists of 3-5 cycles of intensive chemotherapy followed by a single myeloblative chemotherapy with stem cell rescue. Dr. Jonathan Finlay of New York University Medical Center is the contact person although run at a few hospitals in the county (contact information is listed on the site).
- Phase I Pilot Study of Intensive Chemotherapy with Peripheral Blood Stem Cell Rescue in Infants with Malignant Brain or Spinal Cord Tumors This study uses cisplatinum, cycophosphamide, vincristine and etoposide followed by carboplatinum and thiopeta and then stem cell rescue. There are to be three cycles of carboplatinum and thiopeta with stem cell rescue.
- Intrathecal and Systemic Chemotherapy Combined With Radiation Therapy in Treating Young Patients With Newly Diagnosed Central Nervous System Atypical Teratoid/Rhabdoid Tumors Children's Hospital of Philadelphia