Achievements through international collaboration in pediatric
renal tumors
Over the past decades, a focus on collaboration, rather than on
differences in approach, has opened the door for SIOP-RTSG and COG-RTC
to make translational steps on a global level towards better care. An
article of Giulio D’Angio, one of the pioneers in Pediatric Oncology,
addressed the question of pre- or postoperative therapy for Wilms’ tumor
in 2008, when he wrote: “SIOP participants, their North American
colleagues, and other investigators have conducted this debate in a
thoroughly collegial manner. Members of any study are welcome to attend
meetings of other groups, where advice and data are willingly
interchanged. The children have been the beneficiaries, as they should
be.” (5) . It was again Giulio D’Angio, who stated that ‘’the
investigators have achieved what political and religious leaders have
not accomplished so far”, (6) after the very first joint publication,
in which data sets of children with renal tumors up to the age of 6
months were merged illustrating the benefits of such a collaborative
endeavor. (7) These early efforts led to a global ‘’surgery first””
consensus for such young infants. A collaborative consensus guideline
for the management of adult Wilms tumors was developed as well, (8) as
was a meta-analysis on the potential role of high dose chemotherapy with
stem cell rescue for relapse Wilms tumor. (9) Targeting the IGF pathways
was summarized as a collaborate effort resulting from the SIOP/COG ENCCA
conference. (10) Intergroup mentoring of young investigators in the
field of molecular genetics of WT and CCSK revealed the molecular
landscape of DAWT, FHWT and CCSK through the TARGET initiative. (11-14)
More recently, during the HARMONICA era, coordinated parallel
manuscript/research efforts from COG/SIOP have focused on imaging
surveillance, (15, 16) stage 1 DAWT (17, 18) and WAGR and WT. (19, 20)
Collaborative reviews on unmet needs in WT, (21) addressing
international progress in WT, (3) WT phase 1 and 2 studies, (22)
congenital mesoblastic nephroma, (23) renal cell carcinoma (24) Wilms
tumor broadly, (25)) and more recently a comprehensive position paper on
oncofertility issues pertinent to pediatric renal cancer (26) have been
finalized.
Since the onset of HARMONICA, clinical outputs from such international
collaboration have produced practice changes in both cooperative groups.
The COG has adopted post-chemotherapy histology in patients with
bilateral Wilms tumor who undergo delayed nephrectomy, using
post-chemotherapy histologic risk criteria defined by SIOP. The SIOP has
adopted the COG approach to defining lung metastases and select
abdominal radiotherapy dosing guidelines for CCSK. Both groups have
adopted a harmonized definition to relapse Wilms risk classification,
based on upfront treatment intensity and histologic risk criteria. Such
advances only touch the surface of what is possible through data sharing
and meaningful open communication and dialogue.