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Clinical

Clinically, the challenge in advancing care and outcomes for childhood solid tumours lies in the development and coordination of subspecialty care across multiple disciplines, including diagnostic radiology, molecular diagnostics, medical oncology, surgery, radiation oncology, pathology, clinical genetics, and other clinical and allied health services in order to provide holistic, comprehensive care to the child and the supporting family. Patients and their families with childhood solid tumours require prompt and efficient coordination of input and care from these various disciplines at multiple points in their treatment.

Our childhood cancer specialists include paediatric oncology physicians, paediatric oncology surgeons, paediatric neurosurgeons, orthopedic surgeons, pathology and laboratory support, radiation oncology, diagnostic and interventional imaging, nuclear medicine, oncology pharmacy, rehabilitation, nutritional specialists, palliative care service, social workers, neuropsychologists and allied health care professionals. These are supported by oncology resource nurses, transplant coordinator and a nursing team dedicated to the care of central venous access devices which are crucial in the care of these patients. The multidisciplinary team is dedicated to patient care and meets regularly at weekly grand rounds, weekly working tumour boards, as well as monthly solid tumour boards and monthly neuro-oncology boards.

Our facilities include inpatient wards, which has transplant rooms for our allogeneic and autologous stem cell transplantation, as well as a Day Therapy facility. The children’s hospital is also fully equipped with paediatric operating theaters and critical care support, as well as a Children’s Emergency support.

The solid tumours we treat consist of:

  1. Brain tumours – These include both benign and malignant brain tumours. The more common malignant brain tumour conditions include medulloblastoma, high and low grade gliomas, ependymoma, primitive neuroectodermal tumours (PNET), and intracranial germ cell tumours. Rare brain tumours that we see include atypical teratoid rhabdoid tumour, choroid plexus tumur / carcinoma etc.

  2. Musculoskeletal tumours – These include bone and soft tissue tumours such as osteosarcoma, Ewing Sarcoma, rhabdomyosarcoma, non-rhabdomyosarcoma soft tissue sarcomas (NRSTS).

  3. Visceral tumours – This large heterogeneous group include neuroblastoma, hepatoblastoma, kidney tumours (Wilms tumour, clear cell sarcoma of kidney, rhabdoid tumour of kidney, etc), extracranial germ cell tumours, lymphomas, and other rare tumours.

Current initiatives:

  1. Cancer Genetics

    In collaboration with the National Cancer Centre Singapore, we are studying cancer susceptibility and application of next generation clinical sequencing for patients with paediatric brain and solid tumours. Many familial cancer syndromes are associated with adult-onset and childhood-onset tumours. The identification and study of these children and their families has led to the discovery of many genes, all of which have pivotal roles in various stages of human tumourigenesis. Identification of tumour predisposition syndromes in patients who have cancer in childhood is paramount for optimal care.

  2. Paediatric Hepatic International Tumour Trial (PHITT)

    The PHITT is a collaborative trial involving three major clinical groups: the International Society of Paediatric Oncology Epithelial Liver Tumour (SIOPEL), the Liver Tumour Committee of the Children’s Oncology Group, USA (COG) and the Japan Children’s Cancer Group (JCCG). Together with institutions in China, Hong Kong and Taiwan, we are joining the Asian arm of the trial led by the JCCG. The trial uses a risk-adapted approach to the treatment of children diagnosed with hepatoblastoma (HB) and hepatocellular carcinoma (HCC). Evaluation of the biology of HB and HCC using the identification and validation of novel and reported prognostic as well as toxicity biomarkers is also a key strand of this trial. The trial is also designed to optimize the collection of clinically annotated biological specimens and to establish the world’s largest repository of blood and tissue samples from paediatric patients with HB and HCC.

  3. EORTC INTELLANCE 2

    The INTELLANCE 2 study is headed by AbbVie and the European Organization for Research & Treatment of Cancer (EORTC) Brain Tumour Group. As part of the paediatric sub- study, we seek to enroll paediatric patients that have histologically proven high grade glioma with EGFR amplification. It is an uncontrolled, open-label, single-arm global study which aims to evaluate the safety, tolerability, and pharmacokinetics of ABT-414 in a paediatric population less than 18 years of age as well as to assess the effect of ABT-414 on tumour response per Response Assessment in Neuro-Oncology (RANO) criteria.

  4. Ga DOTATATE study

    Neuroblastoma accounts for 6%to 10% of all childhood cancers. Current treatment for high-risk disease is intensive treatment regimen and many children still have refractory disease or relapse and they are further treated with chemotherapy or 131I- metaiodobenzylguanidine (131IMIBG) therapy. The success of (131)I-mIBG scintigraphy and therapy is well known but therapy is limited by poor bone marrow reserve in this heavily pre-treated population. The long-term survival rate is still less than 40%. Thus improved therapeutic options are therefore required for these children. Peptide Radionuclide Receptor Therapy (PRRT) has less acute, renal and hematologic toxicities compared to MIBG therapy.

    Recent preliminary reports suggest that a diagnostic imaging with both 131I-MIBG and 68Ga- DOTAPEPTIDE yielded non-concordant results and thus combination of the two agents may be more effective than either used alone. They may complement each other in being able to deliver targeted radiation to different areas of the tumour, depending on the molecular target expressed.

    It is known that neuroblastoma express somatostatin receptor. However, there is paucity of data describing the percentage and distribution of such patients who would be subsequently suitable to receive PRRT.

    We are studying the prevalence of somatostatin receptor expression in intermediate to high risk patients, relapse and refractory disease, to determine the feasibility of combined therapies for our local patients. We are presently assessing this by using Ga-68 DOTAPEPTIDE PET/CT, a somatostatin receptor specific imaging. The study is open to existing intermediate to high risk patients, or those with relapse and refractory disease. Patients undergo both (131)I-mIBG scintigraphy (which will be used as a reference ‘gold standard’ scan) and Ga-68 DOTAPEPTIDE PET/CT.

For more information, please click on the links below:

Paediatric oncology

Paediatric neurosurgery

Paediatric Surgery