Treatments for recurrent neuroblastoma

Recurrent neuroblastoma means that the cancer has come back after it has been treated. The following are treatment options for recurrent neuroblastoma. The healthcare team will suggest treatments based on your child's needs and work with you to develop a treatment plan.

High-risk neuroblastoma has a greater chance of recurring than low- or intermediate-risk neuroblastoma. In general, when the disease comes back (recurs) in only one area, the prognosis is better than when it recurs in many locations, such as bone and bone marrow.

Treatments for recurrent neuroblastoma are given based on the risk group given to the cancer when it was first diagnosed. The treatments offered also depend on:

• the stage of the cancer at diagnosis
• certain characteristics of the recurrent tumour, such as chromosome changes
• where the cancer recurs
• treatments the child has already received
• the child's overall health

Children first treated for low-risk neuroblastoma who have a recurrence that is found in one place may be treated with surgery or chemotherapy or both.

If the recurrent neuroblastoma has spread to other parts of the body, it is often treated with chemotherapy. Surgery may be done to remove as much of the recurrent tumour as possible.

Chemotherapy combinations used to treat recurrent neuroblastoma include:

• carboplatin, cyclophosphamide, doxorubicin and etoposide
• cyclophosphamide and topotecan
• irinotecan and temozolomide

Find out more about chemotherapy for neuroblastoma.

Children first treated for intermediate-risk neuroblastoma who have a recurrence that is found in one place may be treated with surgery. Chemotherapy may also be given. Radiation therapy may be used if the cancer keeps growing or spreads after chemotherapy and second-look surgery.

If the recurrent neuroblastoma has spread to other parts of the body, treatment often needs to be more aggressive. A combination of therapies are used, including chemotherapy, surgery, radiation therapy, stem cell rescue, retinoids and immunotherapy.

Children first treated for high-risk neuroblastoma who have a recurrence or who have refractory disease (neuroblastoma that does not respond to initial induction chemotherapy) may be treated with a variety of different treatments. One of the most effective regimens is chemotherapy combined with immunotherapy.

Chemotherapy combinations that may be used are:

• temozolomide and irinotecan (sometimes with dinutuximab, an immunotherapy drug)
• topotecan and cyclophosphamide

Find out more about chemotherapy for neuroblastoma.

Sometimes radioisotope therapy with metaiodobenzylguanidine (MIBG) may be used to treat high-risk neuroblastoma that recurs. This treatment is only available in a few Canadian centres and is often given within a clinical trial. Stem cell rescue may be needed after treatment to help the bone marrow to recover. Find out more about radiation therapy for neuroblastoma and stem cell rescue for neuroblastoma.

ALK inhibitors (such as crizotinib) target neuroblastoma cells that have an abnormal ALK gene. ALK inhibitors may be used to treat neuroblastoma that is no longer responding to other treatments if there is evidence that the tumour has an abnormal ALK gene. Find out more about targeted therapy for neuroblastoma.

If the neuroblastoma does not respond fully to these treatments, or if it comes back multiple times, doctors may be able to treat it with newer, more experimental drugs as part of an early phase clinical trial.

Children who have neuroblastoma that recurs in the central nervous system (CNS, or the brain and spinal cord) may have surgery to remove the tumour. Radiation therapy is usually given after surgery.

Children with cancer may be treated in a clinical trial. Clinical trials look at new and better ways to prevent, find and treat cancer. Find out more about clinical trials.