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Pediatric High-Risk Neuroblastoma- Rapid COJEC w/ Complementary Therapy

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Rapid COJEC for high-risk pediatric neuroblastoma can kill the cancer but can also cause short, long-term and late stage side effects. Consider Complementary and Integrative therapies to reduce this risk-

Hi David- my 23 month old daughter has been diagnosed with high-risk pediatric neuroblastoma. My daughter’s neuroblastoma is considered to be stage 4. We are in Europe at the moment so they have proceeded with rapid COJEC protocol.We have started with traditional therapy two days ago as we could not wait any longer.
However we are looking for advice on a complementary treatment to support her immune system and reduce toxicity due to chemo. Are you able to help me? 

Hi Ellen,  I hope you are as well as you can be. I started my reply below with your question, the basics about rapid COJEC therapy and then possible evidence-based non-toxic therapies for you to consider AFTER chemo, to both reduce the risk of relapse plus boost your daughter’s health, well-being.
Three challenges for you as I see it.
1) The risks/benefits of rapid COJEC therapy being the 3 year survival-
2) The short, long-term and late stage adverse events caused by rapid COJEC therapy-
3) the challenge of getting nutritional supplemention, exercise, detox, etc. into a small child. I’m not sure what to suggest other than to encourage you to talk to a pediatrician and consider smoothies with fruit, maybe PediaSure with the capsules opened up with the powders allowed to mix with the fruit and PediaSure.
Lastly, I’m throwing a lot of info at you. Let me know if you have any questions.
Good luck and hang in there,
David Emerson
  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

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Rapid COJEC versus standard induction therapies for high-risk neuroblastoma.

MAIN RESULTS: 
  • Febrile neutropenia (two or more episodes), 
  • proven fungal infections, 
  • septicemia (one or more episodes), 
  • gastrointestinal toxicity (grade 3 or 4), 
  • renal toxicity (glomerular filtration rate < 80 ml/min per body surface area of 1.73 m(2)), 
  • neurological toxicity (grade 3 or 4), and 
  • ototoxicity (Brock grade 2 to 4) were addressed as early toxicities (during pre-operative chemotherapy). 

High-dose rapid and standard induction chemotherapy for patients aged over 1 year with stage 4 neuroblastoma: a randomised trial.

Dose intensity can be increased with a rapid induction regimen in patients with high-risk neuroblastoma. There was no significant difference in OS between the rapid and standard regimens at 5 years and 10 years. However, an increasing difference in EFS after 3 years suggests that the efficacy of the rapid regimen is better than the standard regimen. A rapid induction regimen enables myeloablation to be given much earlier, which might contribute to a better outcome.”

High-Risk Neuroblastoma Treatment Review

“High-Risk Disease- Patients with disease classified as high risk for relapse require strong treatment combining chemotherapy, surgery, stem cell transplant, radiation therapy and immunotherapy. A patient is considered to have high-risk neuroblastoma either because of aggressive characteristics of the tumor cells or the presence of disease in multiple places. Because the outcome for high-risk disease is significantly poorer than for low- and intermediate-risk disease, there are questions regarding the best treatmentchoices. It is most important that children with high-risk disease are:
  • Properly diagnosed by experienced neuroblastoma experts
  • Treated at a hospital with experience in treating and monitoring the disease

The majority of high-risk treatment protocols use some combination of the following procedures:

  • Induction Chemotherapy: Four to six courses of combined drug chemotherapy is given first to reduce the size of the primary and any metastatic tumor (cancer cells that have spread to other parts of the body). The particular medications and doses vary.
  • Surgery to remove as much tumor as possible following the induction chemotherapy.
  • Consolidation Therapy involves stem cell transplant. Standard treatment of high-risk neuroblastoma includes the use of very high doses of chemotherapy followed by an autologous (self-donating) hematopoietic (blood cells) stem cell infusion. This a multi-stage process that involves:
    • collecting stem cells from the patient that will be stored for later use This usually occurs during the induction part of therapy
    • administering very high doses of chemotherapy to eliminate any remaining tumor cells
    • infusing collected stem cells to the patient to restore the bone marrow that has been destroyed by the chemotherapy/radiation

Curcumin induces apoptosis in human neuroblastoma cells via inhibition of AKT and Foxo3a nuclear translocation.

“Neuroblastoma (NB) is one of the most frequent extracranial solid tumors in children. It accounts for 8-10% of all childhood cancer deaths, and there is a need for development of new drugs for its treatment.
Together, these results take evidence for considering curcumin as a potential therapeutic agent for patients with NB.”

Curcumin and resveratrol induce apoptosis and nuclear translocation and activation of p53 in human neuroblastoma.

“Observations suggest that the cytotoxicity, cell cycle arrest and apoptosis induced by curcumin and resveratrol in NB cells may be mediated via functionally activated p53 and merit further study.”

Epidemiological and preclinical studies have revealed that omega-3 fatty acids have anticancer properties. We have previously shown that the omega-3 fatty acid docosahexaenoic acid (DHA) induces apoptosis of neuroblastoma cells in vitro by mechanisms involving intracellular peroxidation of DHA by means of 15-lipoxygenase or autoxidation
 
In conclusion, prophylactic treatment with DHA delayed neuroblastoma development, suggesting that DHA could be a potential agent in the treatment of minimal residual disease and should be considered for prevention in selected cases.”
“Although EGCG induced growth arrest and apoptosis in the parental cells in a dose-dependent manner, it was not effective against spheres. However, EGCG potently inhibited sphere formation in the BE(2)-C cells…” 

In vitro and in vivo efficacy of non-psychoactive cannabidiol in neuroblastoma

“Our results demonstrate the antitumourigenic action of cbd on nbl cells. Because cbd is a nonpsychoactive cannabinoid that appears to be devoid of side effects, our results support its exploitation as an effective anticancer drug in the management of nbl…”

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