One size does not fit all: Dr. Mark Bernstein seeks to tailor cancer treatments to the needs of children and youth
Cancer is relatively rare in children and youth. While this is a blessing, it poses challenges when it comes to treating those children, adolescents and young adults who do develop cancer. "There are no chemotherapy drugs specifically designed for children and youth, primarily because the number of patients is so small," says Dr. Mark Bernstein, head of the Division of Pediatric Hematology / Oncology at the IWK Health Centre and Dalhousie Medical School. "This means there is a lot of work to be done to determine optimal dosing and the most effective combinations of drugs for young people."
Small patient numbers also mean that pediatric cancer treatment centres have to join forces to test new drugs and new combinations of drugs in children and youth. The Children’s Oncology Group, for example, involves 240 centres around the world in as many as 100 trials at any given time. "We have patients enrolled in about 70 of these global trials," notes Dr. Bernstein. "This gives our patients access to the newest medications and treatment protocols, while creating a large pool of data from which we can learn."
Dr. Bernstein explains that while some of the trials are purely therapeutic, testing how well a particular drug or combination works, others have a biological component. These studies examine blood and tumour samples to learn more about childhood cancers.
"Childhood cancer is usually in the form of leukemias, brain tumours, lymphomas, and cancers affecting the kidneys, bones and soft tissues," says Dr. Bernstein, who concentrates his clinical practice on sarcomas arising in the bones and soft tissues. "Adult-type carcinomas are non-existent in children, and rare in youth. Even when carcinomas do arise in young people, they often behave differently than they do in adults. We need to learn more about cancers in children and youth and how the drugs work in them. For example, we want to know if the targets for therapy are the same as in adult cancers, and if there are markers that might indicate a therapy is working."
Dr. Bernstein is a key member of the Atlantic Provinces Pediatric Hematology Oncology Network (APPHON), which is developing a system for delivering care to children and adolescents with cancer and serious blood disorders as close to home as possible. Before coming to Halifax in 2006, he was head of pediatric hematology/oncology at Ste. Justine Hospital and the University of Montreal.
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