Personalized medicine, surgical innovations advance pediatric brain tumor care

The Neuro-Oncology Treatment Program at the Hyundai Cancer Institute at CHOC is doing more than providing the most advanced care for pediatric brain tumors — it’s also helping to shape the future of personalized medicine and surgical innovations.

CHOC offers a full range of standard treatments for brain tumors, as well as personalized therapies for many tumor types, such as medulloblastomas, based on genetic subtyping. Experimental treatments are available through Children’s Oncology Group and other consortium and industry-driven clinical trials. Some of these studies — including a trial developed by a CHOC neuro-oncologist to investigate a vaccine for diffuse intrinsic pontine glioma — are part of CHOC’s robust early-phase clinical trials program, according to Dr. Chenue Abongwa, pediatric neuro-oncologist at CHOC.

Dr. Chenue Abongwa
Dr. Chenue Abongwa, pediatric neuro-oncologist at CHOC

CHOC also partners with some of the country’s foremost healthcare institutions, including Mayo Clinic, to apply the latest genomic sequencing and molecular studies in studying each individual tumor.

When a patient presents with a brain tumor, a wide range of specialists are involved from the beginning. “We have a multidisciplinary neuro-oncology tumor board that includes neurologists, neurosurgeons, neuroradiologists, radiation oncologists, pathologists and a neuro-oncologist, and we involve other specialists as needed,” says Dr. Abongwa. “This expertise allows us to select the treatment likely to be the best option for each child while minimizing the risk of side effects.”

Each patient at CHOC is treated via an individualized, precision medicine approach. When surgery is necessary, CHOC has four highly experienced, board-certified pediatric neurosurgeons who can apply some of the most advanced surgical capabilities. “We have the latest in surgical navigation, and we partner with neurologists at CHOC to offer surgical neuromonitoring to track certain nerve potentials during resections,” says Dr. Suresh Magge, medical director of neurosurgery at CHOC and co-medical director of the CHOC Neuroscience Institute. “If we’re operating near the brain stem, it’s important to know if there’s potential for damage in surrounding structures.”

Dr. Suresh Magge
Dr. Suresh Magge, medical director of neurosurgery at CHOC and co-medical director of the CHOC Neuroscience Institute

Several of the surgical therapies CHOC offers are minimally invasive alternatives to craniotomy. One example is endoscopic surgery, which may be appropriate for tumors located in the ventricles. Neurosurgeons can visualize and resect these tumors using an endoscope inserted through a small incision.

“Certain tumors, especially those located deep in the brain, are amenable to laser interstitial thermal therapy (laser ablation),” Dr. Magge says. “This has revolutionized the treatment of certain types of lesions. We can insert a catheter through a small incision down to the deep part of the brain and ablate the tumor without harming surrounding structures. A ROSA™ (robotic stereotactic assistance) robot allows us to insert the laser with a high degree of precision. Patients experience minimal blood loss and typically go home within a day.”

Once treatment concludes, patients ultimately enter the Neuro-Oncology Treatment Program’s longstanding late effects program. This multidisciplinary program provides long-term follow-up of patients and connects them with specialists who can treat endocrine, neurocognitive, psychosocial and other side effects of treatment.

“For some tumors, such as medulloblastomas, we’ve reached the point where we’re achieving good rates of cure, as high as 80% or more,” Dr. Abongwa says. “So now we’re focused on minimizing the long-term effects of treatment. Most institutions don’t have a strong, long-term follow-up program for pediatric patients. Over time, our program has become quite robust and multidisciplinary. That’s another area of benefit that we offer our patients. We’re a child- and family-focused institution. That focus is evident in all the programs and services that are available to our patients.”

Our Care and Commitment to Children Has Been Recognized

CHOC Hospital was named one of the nation’s best children’s hospitals by U.S. News & World Report in its 2020-21 Best Children’s Hospitals rankings and ranked in the cancer specialty.

Learn how CHOC’s pediatric oncology treatments, expertise and support programs preserve childhood for children in Orange County, Calif., and beyond.

Dr. Jamie Frediani joins Hyundai Cancer Institute at CHOC

A pediatric hematologist/oncologist Dr. Jamie Frediani has joined the growing team of innovative specialists at the Hyundai Cancer Institute at CHOC.  Dr. Frediani looks forward to advancing CHOC’s leukemia and lymphoma programs, as well as the adolescent and young adult cancer program.

“The Hyundai Cancer Institute is experiencing an exciting time of immense growth, including creating new ways of delivering exceptional patient care, developing new treatments, expanding patient outreach and education, and enriching existing treatment teams,” says Dr. Frediani. “I am thrilled to be a part of this growth, and honored to join such a supportive team of experts.”

Pediatric hematologist/oncologist Dr. Jamie Frediani has joined the growing team of innovative specialists at the Hyundai Cancer Institute at CHOC.

After graduating with high honors from University of California, Davis with a bachelor’s degree in microbiology, Dr. Frediani completed medical school at University of Texas Southwestern Medical Center.  Her residency and fellowship training were done at Cincinnati Children’s Hospital and Children’s Hospital Los Angeles (CHLA), respectively.  Throughout her education and training, she assumed numerous leadership roles.  Most recently, she was chief fellow in the department of hematology/oncology at CHLA.  Aside from focusing on delivering excellent, family-centered care, Dr. Frediani would like to enhance the educational curriculum for medical students, residents and fellows, focusing on interactive and case-based learning experiences.

Dr. Frediani’s previous research includes examining the impact of the timing of central line placement in children with acute lymphoblastic leukemia on infection and thrombosis rates; studying perioperative complications in patients with high-risk vascular malformations who underwent surgical or interventional radiology procedures around the site of their lesions; investigating the incidence and clinical course of varicella and herpes zoster in children with acute lymphoblastic leukemia in the pre and post-vaccination era; and studying the outcome of empiric treatment with cefepime versus ceftazidime in pediatric oncology patients with febrile neutropenia.  The latter two studies were conducted in partnership with clinicians at St. Jude Children’s Research Hospital. Her fellowship research in the laboratory of Dr. Muller Fabbri focused on exosomal communication between endothelial cells and cancer cells, leading to miRNA-mediated increased migration of the cancer cells. In addition to numerous abstracts, Dr. Frediani has published in Molecular Cancer, Archives of disease in childhood and Pediatric blood and cancer.

When not caring for patients, she enjoys trips to Disneyland, hiking, and reading, particularly science fiction/fantasy novels. She loves to travel, exploring the world and other cultures.

CHOC Participates in California Kids Cancer Comparison Initiative

Dr-Sender-and-Patient
Dr. Leonard Sender with patient at CHOC

The Hyundai Cancer Institute at CHOC, under the direction of Dr. Leonard Sender, is a proud partner in the California Kids Cancer Comparison Initiative (CKCC), one of two demonstration projects recently selected by the new California Initiative to Advance Precision Medicine, a public-private effort launched by Governor Edmund G. Brown, Jr. CHOC patients will become the first in the state to benefit from big data bioinformatics.

CKCC will give cancer clinicians access to a much broader pool of genetic data than has been readily available, including tumor sequencing data from children and adults around the world. Through the use of a social media platform that maintains the privacy and security of patients’ data, clinicians and patients can upload, analyze and communicate genomic information and associated data. In addition to CHOC, the project includes investigators from UC Irvine, UC San Francisco, Stanford University, USC, the Pacific Pediatric Neuro-Oncology Consortium, including UCLA and UC San Diego, Children’s Hospital of Philadelphia and the Translational Genomics Research Institute.

CHOC’s key contribution to CKCC centers on the clinical trial “Pilot project: Molecular Profiles of Refractory and Recurrent Childhood, Adolescent and Young Adult Cancer.” Patients, whose cancer is either recurrent (returned after treatment) or refractory (not responding to treatment), have tumor and non-tumor specimens collected and sequenced to identify their molecular profiles. The information helps the care team personalize treatment plans, in addition to providing insight on why some cancers respond to therapy or recur despite treatment. As a result of CHOC’s participation in CKCC, these patients will become the first in California to benefit from big data comparisons based on the large cancer genomic datasets gathered and shared by the participating sites.

“The Hyundai Cancer Institute at CHOC made a commitment 10 years ago to invest time and resources in building a strong infrastructure that supports innovative genomic medicine techniques, and we’ve made tremendous progress. The era of precision medicine is here, and we cannot work in isolation. The richer the data, the richer our insight, helping advance clinical leads and new hope for patients and their families,” says Dr. Sender.

Bringing Fertility Preservation to the Forefront of Cancer Treatment

Efforts by the Hyundai Cancer Institute at CHOC to ensure fertility preservation is top of Oncofertilitymind for adolescent and young adult oncology patients, as well as their care providers, were recently profiled by The Huffington Post.

“It is a fundamental right of any individual to be offered fertility preservation,” Dr. Leonard Sender, medical director of the Cancer Institute told the online news site. “If we, as a society, believe in cancer survivorship, then what we need is for people to have a choice as to if they want to have children or not.”

Earlier this year, Dr. Sender co-hosted a workshop on oncofertility at Stupid Cancer’s CancerCon. The goal was to bring together leading experts on fertility preservation to discuss the need and path forward to make fertility preservation a topic of conversation with every AYA oncology patient undergoing treatment at every pediatric hospital in the country.

Read the full article in The Huffington Post.

Fertility Preservation ‘Central’ to Health, Wellness of AYA Patients

Oncology providers administer treatment to approximately 70,000 adolescentFertility Preservation Oncology and young adult patients (AYA) each year in the United States, three CHOC oncology staff members write in HemOnc Today.

Fertility preservation is central to the health and wellness of this population, defined as those aged 15 to 39 years.

As such, it is of great importance to distinguish which patients are at risk for infertility, understand what options — both established and experimental — are available to preserve fertility, and know how to advocate for and educate our patients about those options.

The focus of this article is on AYA patients with cancer, as this population is the most likely to be fertile. However, we understand and appreciate that women and men aged 40 years or older may desire to have a family following their cancer diagnosis and, if this is the case, the same options discussed below may be applicable to these patients.

The desire to have a family is prevalent in young cancer survivors. However, many patients may not raise the topic of fertility preservation at the time of diagnosis for a variety of reasons. They may be overwhelmed by and focused exclusively on the cancer diagnosis. They could be unaware that potential fertility loss may occur, or they might be concerned that pursuing fertility preservation will delay treatment.

Therefore, it is incumbent on the oncology team to properly educate patients whose fertility may be affected by their treatment.

Read the rest of this article from Dr. Leonard Sender, medical director of the Hyundai Cancer Center at CHOC; Julie Messina, an oncology physician assistant; and Keri Zabokrtsky, research program supervisor at the Hyundai Cancer Genomics Center, in HemOnc Today.