Multidisciplinary Approach to Pediatric Cancer Treatment Benefits an Underserved Young Adult Population

As one of the most robust adolescent and young adult (AYA) pediatric cancer programs in the nation, CHOC’s AYA program offers more than comprehensive oncology care to an underserved teen and young adult population — it’s a model for other AYA programs in the country to build upon.

“In the last 15 years or so, we’ve realized there is a huge survival gap in the AYA population, everyone from the age of 15 to 39 years old, whereas over the past 30 to 40 years, we’ve seen significant survival gains in pediatric patients and older adults,” says Dr. Jamie Frediani, pediatric oncologist at the Hyundai Cancer Institute at CHOC. “The AYA population has had very few survival gains, and we believe this is because of a multitude of reasons. They are much less likely to enroll in clinical trials or have access to clinical trials, they do not have the same access to novel new experimental treatments that can improve their survival, their tumor biology is likely different and then there’s a whole host of psychosocial reasons. AYA patients really are their own unique population, and the AYA program at CHOC aims to address that survival gap and to address it from a multipronged approach.”

The multipronged CHOC AYA program focuses on education, research and psychosocial support to increase survivorship within the AYA population.

“Our patients really want to know more about their disease,” Dr. Frediani says. “They want to know more about how their condition impacts their lives whether they’re in treatment or survivorship, such as fertility and sexual education, for example. Our team of experts have education nights with patients to talk about any topics they want to discuss. We have peer mentorship so patients can talk through the highs and lows they experience with someone who’d been through the same thing they’re going through.”

From a research standpoint, Dr. Frediani says the goals of the program are getting more of the AYA patients into clinical trials, knowing where the clinical trial enrollment gap exists and building relationships with adult counterparts to find the best hospitals where AYA patients can be treated.

“We know pediatric diseases do better if a patient is treated at a pediatric hospital. Finding where these patients will do best and forming those relationships to get the most appropriate care is critical. It’s also about finding everything else they need — the supportive medicine, other drugs and different dosing, clinical trials and research projects.”

Addressing AYA patients’ psychosocial needs is the third prong of CHOC’s AYA program.

“I’m a firm believer that multidisciplinary psychosocial supports plays a huge role,” Dr. Frediani says. “Mental health plays a significant role in the treatment of our AYA patients, and I have to believe that affects their outcomes. AYA patients are at a critical juncture in their lives where they’re trying to seek independence. A lot of them are having kids, getting married, starting new jobs, going to college — all these critical life transitions are happening. When you put cancer on top of that, the natural order of this time in their lives is completely disrupted. Social workers, child life specialists, psychologists, case managers, music therapists — all of our resources help our patients know we truly understand their feelings and needs and are here to help them in every way we can.”

CHOC’s AYA program was developed around 2014 and was one of the only AYA programs in the nation to offer such a comprehensive range of services. Dr. Frediani notes that while some AYA programs in the United States today have a heavier focus on treatment, nurse navigation and clinical trials, others are more support-group focused. CHOC is unique because its program is a hybrid of both.

“Our AYA program has a depth that most programs do not. We have this very robust psychosocial support and clinical trial programming around ours. I think we are unique in the amount of resources we provide for our AYA patients. Addressing cancer from our multipronged approach with a multidisciplinary team ends up being so important.”

The strength of CHOC’s AYA program is rooted in the institution’s values and commitment to providing comprehensive cancer care.

“CHOC comes from a community-based model of medicine,” Dr. Frediani says. “We value the bedside relationships with patients, spending time with them and taking care of not just their medical disease, but everything else around it. I see that across our team, from our nurses to our physicians to our social workers to our child life specialists. Everyone is here to stand with our AYA patients and to help them live whatever life they want to live, in whatever way that means. Other physicians should know CHOC wants to help their AYA patients in any way we can, from offering second opinions to helping with fertility preservation to checking on the availability of a clinical trial. I want to make sure there’s not a person in this age range who goes without these critical resources, without knowing this program is here for them.”

Our Care and Commitment to Children Has Been Recognized

CHOC 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.

Clinical Trials Continue the Advancement of Pediatric Oncology Treatment

Children, adolescents and young adults with cancers that do not respond to traditional treatments continue to find new treatment options because of CHOC’s extensive efforts and active engagement in clinical trial research.

The Hyundai Cancer Institute at CHOC Children’s is a member of the Children’s Oncology Group (COG) and one of only 21 elite facilities in North America and three in California that has received a prestigious Phase 1 clinical trial designation to offer COG’s investigational, potentially promising and innovative clinical trials. COG is the most experienced organization in the world when it comes to the research and development of new therapeutics for children and adolescents with cancer.

“I’ve witnessed the dramatic progress made in the survival of our pediatric patients because of clinical trials,” says Dr. Ivan Kirov, medical director of oncology and the Hyundai Cancer Institute at CHOC Children’s. “Clinical trials are the mortar behind our successes here at CHOC.”

Dr. Ivan Kirov, medical director of oncology and the Hyundai Cancer Institute at CHOC Children’s
Dr. Ivan Kirov, medical director of oncology and the Hyundai Cancer Institute at CHOC Children’s

CHOC currently offers more than 140 clinical trials in varying phases, including multiple pharmaceutical industry-sponsored clinical trials. Besides membership in COG, CHOC is also a member of the Therapeutic Advances in Childhood Leukemia & Lymphoma consortium (TACL), which offers novel treatments in Phase 1 studies for childhood leukemia and lymphoma; the Lymphoma consortium; and the UC Children, Adolescent and Young Adults Cancer Consortium, which includes all of the University of California pediatric oncology programs.

Among the research at CHOC is an upcoming clinical trial for the treatment of diffuse intrinsic pontine glioma (DIPG), a highly aggressive and one of the most difficult-to-treat childhood tumors.

“We are in the process of opening and initiating this clinical trial which, in my opinion, will be extremely important for patients in the future,” Dr. Kirov says. “DIPG is a brainstem tumor which is universally deadly, and very few patients survive more than a year, or even six months. CHOC, the Dana-Farber Cancer Institute in Boston and Lurie Children’s Hospital in Chicago are the only three sites where this new study will be offered. This study will explore a new vaccine for the treatment of DIPG in combination with checkpoint inhibitors. We’re hoping this study will be open in the next several months to offer hope to patients with this disease.”

While clinical research is fundamental to advancing pediatric oncology treatments, Dr. Kirov said the trials themselves are only part of CHOC’s comprehensive approach to helping children and young adults survive cancer.

“These cutting-edge medications and products we are testing, including new targeting agents, monoclonal antibodies and various types of small molecules and vaccines, for example, require an extremely strong supportive and clinical research infrastructure, which CHOC can offer,” says Dr. Kirov. “Our highly educated clinical research coordinators, physicians-scientists, nurses, educators, pharmacists, and other professionals, along with our unparalleled supportive services for both patients and their families, such as social workers, psychologists, child life specialists, palliative care experts and spiritual services, make our patients’ experiences at CHOC unique, and I think this is why CHOC truly stands out. In fact, many patients who come to CHOC for Phase 1 studies express their desire to stay here even after the study is completed, which really speaks very highly of CHOC and the continuum of care and support we provide to young patients and their families.”

Our Care and Commitment to Children Has Been Recognized

CHOC Children’s 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.

In the Spotlight: Chenue Abongwa, M.D.

Chenue Abongwa, M.D., joined CHOC Children’s in October 2018 as a pediatric neuro-oncologist at the Hyundai Cancer Institute. After finishing medical school at the Universite de Yaounde in Cameroon, he completed his pediatrics residency at Brookdale University Hospital in New York, his pediatric hematology/oncology fellowship at University of Iowa Hospitals and his neuro-oncology fellowship at Children’s Hospital of Los Angeles. We chatted with him about his time at CHOC so far.

Dr. Chenue Abongwa, Pediatric Neuro-Oncology

What drew you to medicine? Pediatrics specifically?

I was drawn to medicine earlier in my childhood. My mother worked as a nurse, and I often accompanied her when she did house calls to visit children and was very impressed by her dedication and desire to help sick children. I wanted to be like her when I grew up.

What about CHOC stuck out to you?

I initially heard about CHOC in 2013 when I was a fellow in pediatric hematology/oncology and came across a well-written web guideline on febrile neutropenia. This prompted me to seek information about the institution and about the team. I was very impressed by the institutional vision, dynamism, patient-centeredness and search for excellence. I applied without hesitation when the opportunity came.

Are you or do you plan to be involved with any special projects or groups at CHOC?

I am currently involved in several divisional clinical projects based on COG (Children’s Oncology Group) and will be joining some committees.

Can you share some of your goals at CHOC?

My goals are to initially build a strong clinical base by working in the neuro-oncology team in the short term. I hope in the long term to be actively involved in quality improvement, research and teaching.

What do you want your patients and their families to know about CHOC? 

The diagnosis of cancer in a child is a very difficult and traumatic experience to children and their families. Being part of their lives in these extremely difficult periods and advocating for these families is a great privilege. Our team here at CHOC, with its focus on patient-centered care, is the right place for these families to be during this time.

What do you like to do outside of CHOC?

I love traveling, watching football and playing chess.

Premier CHOC leukemia and immunotherapy conference draws international experts

A premier CHOC Children’s symposium centered around the complex issues facing pediatric leukemia patients drew more than 150 international leaders in the field of children’s leukemia treatment and research. This two-day conference had 33 speakers from various renowned institutions.

Building on the scientific foundation and exchange of information established in the gathering’s five-year history, attendees of the 2018 Society of Young Adult Oncology (SAYAO)/CHOC Children’s Leukemia Symposium shared the latest scientific and clinical advances in acute leukemia, specifically immunotherapy.

CHOC Children’s physician Dr. Van T. Huynh, chaired the symposium and presented her research on asparaginase therapy and silent inactivation.

Titled “From Pediatric to Adult Acute Lymphoblastic Leukemia – The Age of Cellular Therapy,” the Nov. 5 and 6 symposia focused largely on CAR-T cell therapy and new agents for the treatment of acute leukemia. Specific topics included:

  • an update on CAR-T cell products and trials;
  • the future of CD 19, CD22 and NK CAR cell trials;
  • the economics of CAR-T cell therapy;
  • update on leukemia therapy for pediatrics and adolescent and young adults; and
  • supportive care and oncofertility for the leukemia patient.

The symposium drew more than 150 international pediatric leukemia leaders and 33 speakers from various renowned institutions.

The symposium was chaired by CHOC physician Dr. Van T. Huynh, who also presented her research on asparaginase therapy and silent inactivation. CHOC physician Dr. Carol Lin discussed toxicity and management of asparaginase therapy.

Learn more about referring a patient to the Hyundai Cancer Institute at CHOC Children’s.

Dr. Jamie Frediani joins Hyundai Cancer Institute at CHOC Children’s

A pediatric hematologist/oncologist Dr. Jamie Frediani has joined the growing team of innovative specialists at the Hyundai Cancer Institute at CHOC Children’s.  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 Children’s.

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.