Immunotherapy in Pediatrics

dc.creatorAguilar, Rocioen_US
dc.creatorWojciechowska, Nataliaen_US
dc.creatorMurray, Laurenen_US
dc.creatorRay, Anishen_US
dc.description.abstractBackground: Immunotherapy has emerged as a promising treatment approach, specifically designed to boost the response of the immune system to target tumor cells while sparing nontumor tissue. This treatment not only holds the potential for enhanced efficacy but also translates into reduced adverse effects on patients while improving outcomes. Despite its early success, the application of immunotherapy has largely been confined to adults, with slow adoption noted in the treatment of pediatric malignancies. Case Information: Here the objective is to demonstrate a single institution’s experience with immunotherapy in pediatric oncology, to further the exploration of these treatment modalities in the treatment of children with cancer. In our review, we studied a database of 48 pediatric patients out of 226, expressing programmed death ligand 1 (PD-L1), of which 7 have undergone immunotherapy. In this project, we studied various tumor types in which immunotherapy found its utilization. We also noted adverse effects associated with this particular therapy as well as efficacy. We believe immunotherapy is poised to deliver a positive impact in the realm of pediatric patients. 7 pediatric patients with positive expression of PD-L1 received immunotherapy, involving nivolumab alone or in combination with ipilimumab or brentuximab. Hodgkin lymphoma (n=2), metastatic melanoma (n=2), histiocytic sarcoma (n=1), rectal carcinoma in the context of constitutional mismatch repair deficiency (cMMRD) (n=1), epithelioid and spindle cell hemangioma (n=1) comprised the diagnoses. Patients received between 4 and 18 cycles of immunotherapy. Out of all patients who had completed their immunotherapy regimens (n=5) or remained on treatment (n=2), 6 achieved remission or had stabilized disease. The diagnoses responding to treatment included Hodgkin lymphoma (n=2), metastatic melanoma (n=2), rectal carcinoma due to cMMRD (n=1), and epithelioid and spindle cell hemangioma (n=1). Unfortunately, after 13 months in remission, the patient suffering from histiocytic sarcoma experienced reoccurrence in the duodenum. Immune-related adverse events included mild allergic reactions, prodromal symptoms, anemia, neutropenia, transaminitis, endocrinopathies, and self-limiting neuritis. Conclusions: This report highlights the positive impact immunotherapy can have in the realm of pediatric malignancies, with the possibility of tumor regression or stabilizing disease. Further research is needed to accurately identify pediatric oncology patients that could benefit from immunotherapy.en_US
dc.titleImmunotherapy in Pediatricsen_US