Tuesday, March 10, 2009

Seeing the trees in the MIBG forest

One of the great things about the NANT meeting is that it is an in depth look at very specific research. The amount of research that has been done on any one subject is extensive. It is one thing to go to a seminar and convention to hear about one study on a topic but it is quite a different experience to here about 10 different studies on that same subject one after the other. I am not just talking about neuroblastoma either. Let's take MIBG therapy, for example, as it has always been a subject which intrigues me but not one that I have written a lot about. You can go to a convention or seminar and hear a presentation on MIBG. Maybe if you are lucky it might even include information about a particular clinical study. At the NANT it is completely different. You will likely here everything that was ever known about MIBG. In one sense it is a comprehensive overview of every preclinical and clinical study on MIBG ever known to man and the important research nuggets of information that are needed to make decisions. You get a very good understanding of what is known on the drug and you are better able to understand and predict how it may be used best both now and in the future.

As a father, I have always understood MIBG therapy to be a type of targeted radiation. I knew it worked in some kiddos and not others. Finally, I knew that it was available in one trial or another. What I never necessarily understood clearly was why it was available in the combinations it was? What was the big picture? It is one thing to see this from the perspective of a parent of a child who was looking for a therapeutic option and quite another from the perspective of a researcher that was trying to maximize its usefulness and maybe even cure the disease. You may laugh. "MIBG therapy curing neuroblastoma?" Come on! Yes, you heard me say it. In fact, there are examples of MIBG creating complete remissions in adult cancers - adult cancers which may not be as hard to defeat as neuroblastoma.

I am not saying that MIBG is a cure for neuroblastoma today. However, the potential of therapies like this to create that type of effect are very real. Not only could I see MIBG therapy as an important component of many children's treatment regimens but I can also see it as the treatment that makes the difference between life and death for some.

That is a pretty strong statement, isn't it?

The point is not that MIBG therapy is the answer. Rather, the point is that the science is improving and even at this point in the game we are already seeing some remarkable successes. It is a subject that is part of my third unwritten rule to neuroblastoma treatment but I can tell you that there is very definitely a group of patients who should have this therapy on their radar. If you have MIBG avid disease and it is refractory or relapsed, if it is solid tumor or bony disease, it should be something that you are talking about. It should be a consideration. It may be inappropriate for your child, the timing may not be right but it is another weapon in your arsenal that should be considered with your oncologist (or preferably an expert) if you fall into this category.

It is the science of purpose.

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