A cheap simple test could accurately predict the recurrence of a childhood cancer.
Researchers at Brunel University London and University College London have pinpointed a protein marker, which when absent, shows neuroblastoma is almost certain to recur.
It means children with low-risk neuroblastoma, who don’t have the biomarker called PML, can be reclassified as at high risk of relapse and have chemotherapy earlier.
“We have found the absence of PML a very precise marker of tumour recurrence,” said study co-authors, Professors Paolo Salomoni, at UCL and Brunel’s Arturo Sala.
High risk neuroblastoma, which occurs mostly in children under five is treated with surgery and chemotherapy. And neuroblastomas currently rated low risk are just removed or left untreated while doctors ‘wait and see’. But a fraction of low risk tumours recur and ultimately kill.
“In the low risk tumours, the absence of PML will be a very useful marker,” said Prof Sala. “What we can now say is that even some tumours classified as low risk, that would have previously gone untreated, if they show no expression of PML, they ought now to be classified as high risk.”
The next step is a study to confirm that lack of PML positivity can predict poor prognosis. Then would come a clinical trial using PML positivity to guide clinical intervention.
Neuroblastoma, which affects about 100 UK children a year, attacks the peripheral nervous system, which controls muscles, organs and senses. It usually appears as a tumour in the chest or tummy and diagnosed with a needle biopsy. The PML marker could potentially be screened at diagnosis at a cost of a few pounds per test. It could save several UK children every year and be ready for regular NHS use within 2-4 years.
“It is an immediately applicable diagnostic tool,” said Professor Sala. “The cost is relatively small – it is just done by microscope inspection and could be used whenever a child is diagnosed by biopsy. If you save one child it is worthwhile.”
The study was sponsored by The Wellcome Trust and done in collaboration with the UCL Cancer Institute/UCL CRUK Centre and the UCL Institute of Child Health.
Article: A promyelocytic leukemia protein-thrombospondin 2 axis and the risk of relapse in neuroblastoma, Paolo Salomoni, Clinical Cancer Research, doi: 10.1158/1078-0432.CCR-15-2081, published online 13 April 2016.