CHILDREN'S CANCER STUDY GROUP

CCG has the expertise to combine whole group protocol studies with small
intra-group investigations of tumor biology. Large scale clinical programs are
needed to consolidate data accrual of the past decade. Included in small group
studies are those utilizing data on experiments in nature, i.e., adenosine
deaminase (ADA) deficiency; anti-cancer effects of interferon; anti-tumor
antibodies (common ALL, neuroblastoma); transplantation (allogeneic, autologous)
biology; autologous lymphocyte therapy; radiosensitizer therapy; limb salvaging
techniques/aggressive metastatic surgical attack; and diagnostic imaging
procedures. Induced ADA deficiency can be applied to the study of T-cell
leukemia and to the nature of lymphoblast modulation. Interferon data can be
applied to the study of non-T ALL, non-Hodgkin's lymphoma and osteosarcoma and
to the nature of tumor cell death. Anti-(common) ALL antibody studies can be
applied to the development of common ALL and non-T, non-B lymphoma protocols.
Specific anti-neuroblastoma antibody data can be applied to the development of
randomized studies comparing chemotherapy and chemotherapy plus adjuvant
antibody therapy. Allogenic transplantation for AML can be expanded to
relapsing high risk ALL and high risk lymphoma. Autologous marrow
transplantation rescue is applicable for megadose therapy studies of leukemia,
lymphoma and a variety of solid tumors and as a means of evaluating techniques
for identifying occult tumor burdens. Similarly, autologous lymphocyte infusion
into brain tumors can test the hypothesis that such malignancies occupy
immunologically priviledged sites and in turn be incorporated into a randomized
radiosensitizer therapy study. Conflicting osteosarcoma data can be resolved by
comparing pre-op megadose therapy to surgery alone (including evaluation of
transfer factor, limb salvaging, and evaluation of the time/therapy sequence in
treatment of metastatic disease). Extensive investigation of new agents is
required in high risk Wilms' and Ewing's sarcoma and rhabdomyosarcoma. Efficacy
studies of appropriate imaging techniques are mandated in virtually all
protocols in which tumor delineation is essential. And in all studies active
participation by nurse specialists should be encouraged in order to enhance
protocol development.