Bone Relapse help

Hi.

My son relapsed in left arm 1 x 1 cm spot ( Bone ), 3 weeks later a small spot in his right leg ( Bone ) and now his legs started to hurt a little,
so we of course fear the worst.

We have Scans on thursay.

Since relapse we have done 2 cycles of Topo/Cyclo while we were waiting for the BEACON 2 trial to open, but its still not open and nobody knows when its gonna open, and our doctors wants to start him on treatment friday next week. ( If we have good response on Topo/cyclo i guess we continue on that )

I dont think we have time to wait for getting option 3 through, and leaning towards HD ICE followed by option 3 or 4 and then radiation - if clear after that then DFMO.

SO - we are left with more or less 4 options right now.

1: HD ICE

2: TVD

3: Dinutuximab beta with I/T - BUT … we live in Denmark, Europe where this option is not available, but i might fight for it and get it through because our
Medical counsil have said that Dinituximab also are for relapse. I might take some time to get it through and our doctors are not convinced, and missing data
showing effect. On the other hand, they say that BEACON 2 is the right thing to do in our case - and that trial has Dinutuximab beta with I/T and favors it 2:1.

4: HU3f8 with GM - this is only a option if Topo/Cyclo didnt do anything, and im no sure this is the rigth thing to do as the first thing.

A few questions pop up:

HD ICE - is it succesfull with boney dicease?
HD ICE - Do you always need stemcell rescue, and should we opt for harvest stemcells before we start it.

Any other recommendations?

As always thanks for your help navigating cancerland!

Daniel

I don’t know what the best option is for you but in our case (heavy disease in bone - skull, spine, pelvis, femurs etc.) we had no response to induction (frontline chemo) and had bone pain crop up during long lag after starting Ch14.18 (Dinutux) w/ I/T, while awaiting MIBG treatment. Symptoms did not respond to Cyclo/topo.
We irradiated the symptomatic areas (3 separate radiation courses to address bone pain) all the while doing Ch14.18 I/T. Ch14.18 seemed to work for a while (7 rounds) but we were not making any gains towards reducing disease. We are doing MIBG now and are hoping he can get through the lag afterwards without bone pain. Some hint of pain in the arm today but hard to tell if that is disease related (we always fear that). We have never been free of disease so are refractory HR stage 4 NB.
We harvested stem cells early on and may get SC rescue depending on counts. We are hopeful that MIBG will reduce some more of the disease since he responded well to traditional radiation. Last MIBG scan showed no new spots but persistent disease in areas not treated by radiation. We anticipate doing Hu3f8 at some point (with I/T if able). HD ICE still considered but will see how we do with MIBG. Ch14.18 worked well for a while - I believe it saved his life when we first started it, just became less effective later on I guess. We are in the US.

I understand that SJD Hospital in Barcelona used a combination of ICE and hu3f8 for the first time (anywhere) earlier this year and the early results indicate it has had an impressive impact (boney neuroblastoma) with first scan results being clear.

Hi Meg.

You never know what works for your child, you just trying to gather as much information, so you can make the best decision, together with your doctor. So thanks so much for sharing!

You have been through a lot already i can see, really hope you find your way.

I think we end up with HD ICE and hopefully get into the HU3F8 trial with GM-CSF after. Getting into the new trial with the combo of HD ICE and HU3f8 are not an option for us at this stage unless we pay ourself.

Again thanks for sharing.

Daniel

Thanks for sharing Carol.

I just talked to the parents on FB who was the very first to do this trial.

Sounds really promissing.

Will follow the trial and seek more data.

Daniel

Hi Daniel,
Sorry to hear about your situation. We are in Australia and our daughter relapsed in her elbow 6 weeks after completing SIOPHEN treatment for stage 4 HR. Our oncologist recommened us for a trial with a drug called Venetoclax in combination with cyclo/topo chemo. We have now done 5 rounds and it’s showing promising results. Likely a few more rounds, then MIBG treatment then lots of rounds of CH.14 with I/T. Hope this is somewhat helpful. We felt we really had to be guided by our oncologist in this relapse phase.

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Hi, Daniel. Sorry to hear that. My daughter suffered bone relapse from March last year. After 8 cycles of Chemo in China she still had 3 spots in her spine. So we came to SJD in Barcelona for Hu3f8. Thanks god she was CR after 4 cycles of immunotherapy. And as I know there are some children (bone replase) getting CR after 2 or 4 cycles. Some are undertaking Hu3F8 + Chemo. Maybe it is a good option for you. Good luck.

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Hi.

Just a Quick Update.

We did two rounds of topo/cyclo that didnt have any effect.

Then two rounds of HD ICE, and just got scans Yesterday that there are no new spots and the two spots he has had Got smaller. :crossed_fingers:

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If chemotherapy is not effective, you may trial 131I-MIBG radiotherapy for bone metastases. It is effective in about 30-40% patients.

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Today we did infusion number one of HU3f8

Tough but he did it and are fine now.

Pain after 17 minutes, breathing trouble and very low bloodpreassure.

Strong boy. Be lucky.