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European collaboriation improves treatment and research

Collaborating with European scientists improves the treatment of children with cancer worldwide. For example, Dr. Hans Merks and Dr. Reineke Schoot of the Prinses Máxima Center are working from various collaborations to find better treatment protocols for children with sarcoma, a tumor in the bone or so-called soft tissue. Reineke Schoot also coordinated the compilation of a list of essential medicines designated by 54 European colleagues for the treatment of childhood cancer.

Of the 600 children diagnosed with cancer each year, about 72 children (12%) have a sarcoma. More than half of these children have a tumor in the soft tissue, mainly muscle. The remaining children have an osteosarcoma or Ewing sarcoma, both bone tumors. In many cases, this type of cancer is well curable, but when it has metastasized or has a high-risk profile, the outlook is not good. The goal of European clinical trials is to achieve better treatment of sarcomas.


Hans Merks, research group leader and pediatric oncologist says: 'Research into better treatments remains important, because we want to cure every child with a sarcoma. We need to make progress through clinical trials in which we test the efficacy and safety of new treatment methods in children with a poor prognosis. We are also investigating the biology of the tumor and whether we can use various radiological scans and blood tests to predict whether children respond well to therapy. If this succeeds well, we will soon be able to give each child the most appropriate treatment. Fortunately, sarcomas are rare, which is why we work closely with other hospitals throughout Europe and beyond. This is because in order to draw reliable conclusions, the research group must consist of enough children. And also: all starting points for the study must be the same. For example, every child must be treated according to the same protocol and data must be kept in a similar way, making data comparable.'

Multi-arm study

Thanks to European and broader international collaborations, several studies have already been conducted. For example, Schoot and Merks recently published the results of two international studies EpSSG MTS 2008 and BERNIE in Journal of Clinical Oncology . These studies included a total of 372 children from twelve countries. Schoot and Merks saw a small improvement in the survival of children with metastatic rhabdomyosarcoma thanks to a new more intensive treatment regimen followed by low-dose maintenance therapy. Reineke Schoot, pediatric oncologist and researcher says: 'Although we see improvement, this is still not enough. This is why we recently opened another study in collaboration with the European paediatric Soft tissue Sarcoma Study Group. In this so-called multi-arm study, we are investigating from different angles how to further increase the survival rate. For example, we are comparing different lengths of maintenance therapy, the effects of adding a new chemotherapy combination and intensification of radiotherapy to the treatment plan.'

Essential medicines

Reineke Schoot, together with 54 European colleagues, including several pediatric oncologists from the Máxima, among others, compiled a list of essential medicines for the treatment of childhood cancer. The list was compiled by systematically evaluating European treatment protocols and abstracts from the literature. She published it in the leading journal The Lancet Oncology as one of the research coordinators in European SIOP context. This project is part of the SIOP Europe access to medicine project. The goal of this project is to change unequal access to medicine for the treatment of childhood cancer across Europe. The result is a list of 66 essential medicines. She says: 'Every child with cancer should be able to get the medicines they need, regardless of the country they live in. With this list we give policy makers in the various European countries, doctors and patient organizations a basis to work on continuous availability. In addition, we are sharing this list with a special committee of the World Health Organization (WHO EMLc). Our goal is to thus complement the already existing list with essential medicines for the treatment of children with cancer. In short, this list shows how important and valuable these kinds of international collaborations are for every child with cancer, in the Netherlands and abroad.'