Certain cancers have been treated with cytokines, biologic response modifiers, or monoclonal antibodies in addition to standard treatments. Targeted therapies specifically target the tumor cells, sparing normal host cells. Imatinib mesylate is a protein kinase inhibitor that targets the effects of the t(9;22) translocation of chronic myeloid leukemia and acute lymphoblastic leukemia. Rituximab is a monoclonal antibody directed against the cell surface antigen CD20 expressed in some lymphomas. Ch14.18 is an anti-GD2 monoclonal antibody used for neuroblastoma.
Supportive care also plays an important role in pediatric oncology, including the use of appropriate antimicrobial agents, blood products, nutritional support, intensive care, and integrative therapies.
Because chemotherapy agents are cellular toxins, numerous adverse effects are associated with their use. Bone marrow suppression, immunosuppression, nausea, vomiting, and alopecia are general adverse effects of commonly used chemotherapy drugs. Each chemotherapy drug also has specific toxicities. Doxorubicin can cause cardiac damage; cisplatin can cause renal damage and ototoxicity; cyclophosphamide and ifosfamide can cause hemorrhagic cystitis; and vincristine can cause peripheral neuropathy. Radiation therapy produces many adverse effects such as mucositis, growth retardation, organ dysfunction, and the later development of secondary cancers. Significant therapy-related late effects may develop in pediatric cancer patients (Table 154-3).
Alkylating agents; radiation Second cancers Genetic predisposition; radiation; alkylating agents, etoposide, topoisomerase II inhibitors Sepsis Splenectomy Hepatotoxicity Methotrexate, 6-mercaptopurine; radiation Hepatic venoocclusive High-dose, intensive chemotherapy disease (busulfan, cyclophosphamide) ± bone marrow transplant Scoliosis Radiation Pulmonary (fibrosis) Radiation; bleomycin, busulfan Cardiomyopathy Doxorubicin, daunorubicin; radiation Leukoencephalopathy Cranial radiation ± methotrexate Cognition/intelligence Cranial radiation ± methotrexate Pituitary dysfunction Cranial radiation (growth hormone deficiency, panhypopituitarism)
Psychosocial Stress, anxiety, death of peers; conditioned responses to chemotherapy