What`s new in Wilms tumor research and treatment?

Much of the research going on in the area of Wilms tumor is coordinated by the Children's Oncology Group (COG), whose main goal is to improve the treatment and quality of life of children with Wilms tumor and other types of cancer. COG is a large group of doctors, nurses, scientists, and other health professionals whose hard work has already saved the lives of thousands of children with Wilms tumor.

Biology of Wilms tumors

Research is continuing to unravel how changes in certain genes cause Wilms tumors. Different genes seem to be involved, which might affect how aggressive certain tumors are likely to be.

As doctors have learned how to treat Wilms tumors more effectively, they have begun to look for ways to determine which children might be spared from more intensive treatment. They are also looking for ways to identify children who might need more aggressive treatment to be cured. For example, recent studies have shown that Wilms tumors with certain changes on chromosomes 1 or 16 seem to be more likely to come back after initial treatment. Doctors are now studying whether children with such tumors might benefit from more intensive treatment.

Researchers are also studying the molecular changes that seem to cause Wilms tumor cells to grow and spread. This may lead to treatments that are specifically targeted to correct or overcome these changes.

Treatment of Wilms tumors

Clinical trials continue to study ways to improve treatment for children with Wilms tumors. Earlier studies identified treatments that were very effective in curing Wilms tumors with the most favorable histology. Current clinical trials are studying ways to treat these cancers successfully while reducing side effects as much as possible. For example, studies are looking at whether young children with very favorable outlooks need any treatment other than surgery.

Many studies are looking to improve upon current chemotherapy treatments. For example, recent studies from Europe suggest that in some cases chemotherapy may not need to be continued as long as previously thought.

The outlook for patients with Wilms tumors with unfavorable histology is not as good, and doctors are continuing to study more intensive and more effective treatments for these children. Newer chemotherapy drugs such as topotecan and irinotecan are now being tested.

Other studies are looking at bone marrow or peripheral blood stem cell transplants, which let doctors give higher doses of chemotherapy than the body normally could tolerate. This approach might help treat tumors that are not responding to standard treatments or that would otherwise have a poor outlook.

As researchers have learned more about the gene changes in Wilms tumor cells, they have started to develop newer drugs that specifically target these changes. Targeted drugs work differently from standard chemotherapy drugs. They often have different (and less severe) side effects. Targeted therapies have already become standard treatments for some kinds of cancers of adults.

Because Wilms tumors with favorable histology are usually cured with surgery and chemotherapy, and because Wilms tumors with unfavorable histology are uncommon, most research on targeted drugs so far has been done on cells growing in lab dishes or in animals. Eventually, researchers hope to test these new drugs in clinical trials, so that they may someday have a role in treating children with unfavorable histology Wilms tumors.