The heads of the Pediatric Hematology-Oncology service Lucas Moreno and Antonio Pérez-Martínez
fight in form coordinated and multicentric the pediatric cancer in Spain is the main objective that hopes to reach the Spanish Society of Pediatric Hematology and Oncology (Sehop) through a new initiative, baptized as pencil project. The coordinator of this new strategy is Lucas Morenohead of the Pediatric Oncology and Hematology Service of Hebron Valleyhospital that will coordinate the almost 50 centers children with cancer in Spain currently have.
The program has received public funding through the Carlos III Health Institute and focuses on generating nodes depending on the skills and abilities that each of the centers involved. As stated by Lucas Moreno in Medical Writingit is vital that the project is “multicenter and multirregional so you can move forward. In addition, a autonomic coordination so that the project reaches all the centers, thanks to the creation of multidisciplinary regional committees”.
The head of the Pediatric Hemato-Oncology Service of the La Paz University Hospital, Antonio Perez-Martinez, has also collaborated closely to carry out this project, which began to progress at the beginning of this year. The specialist from Hospital La Paz highlights one of the key aspects of the project, the knowledge flow between the centers involved: “We are in the design phase of these nodes that will bring together different centers and hospitals so that what travel from one center to another don’t be the patientbut the biological material and knowledge so that there can be a return in a timely and adequate manner.”
How was the Pencil Project born and what goals have been set for pediatric cancer?
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The aim of the project is to increase the scope of personalized medicine |
Lucas Moreno, head of the Pediatric Oncology and Hematology Service of Vall d’Hebrón: We at the Spanish Society of Pediatric Oncology and Hematology have been working for years in a personalized medicine group, seeking to understand what the situation was for pediatric cancer. We learned that patients had very uneven access to sequencing techniques for different types of pediatric cancer.
With this situation of great need, thanks to the call of the Carlos III Health Institute for personalized medicine projects, we created the project to unite all the members of the scientific society that worked in different personalized medicine activities to launch the Pencil Project . It has started this year and we are taking the first steps. The goal is to ensure that personalized medicine reaches all patients in any hospital.
What role has the Carlos III Health Institute played?
Lucas Moreno: This is the financing body of the project. It is a call that is very focused on the implementation of personalized medicine, not on making discoveries. When we finish the project, all the regional health systems will have made progress so that this is incorporated into the services.
How will this project be implemented in Spain with regard to precision oncology?
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90% of all centers with children with cancer participate in the project |
Antonio Perez-Martinez, Head of the Pediatric Hematology-Oncology Service at La Paz University Hospital: “We are drawing an initial analysis after seeing what the map of the current situation of personalized medicine in childhood cancer was. The almost 50 centers that currently have children with cancer have difficulty in carrying out a good approach.
We are looking at how to try to make the project bring equity and accessibility to the new tools. From the scientific society, different nodes are proposed depending on the competences and capacities that each of the centers has. We are in the design phase of these nodes that will group different centers and hospitals so that what travels from one center to another is not the patient, but the biological material or knowledge so that there can be a return in a timely and appropriate manner. 90 percent of all centers with children with cancer participate in the project.”
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“Biological material and knowledge must travel from one center to another, not the patient” |
Lucas Moreno: For the project to advance, it needed to be multi-centre and multi-regional. Up to 8 autonomous communities had to participate. There is a coordinating center which is the Vall d’Hebron Hospital, as well as beneficiary centres. There is a structure of these genomic centers that are already working and then a regional coordination has been created so that it reaches all the centers, thanks to the creation of multidisciplinary regional committees.
What functions does the Vall d’Hebrón Hospital have as a coordinating center?
Lucas Moreno: This is a truly collaborative project, bringing together the efforts of many people to reach our patients. Vall d’Hebron assumes the coordination part, of understanding that each of the participants has different tasks and we make sure that all of them are up and running. In the project there are some objectives that are to ensure that all patients have access to sequencing with a panel, to ensure that when patients relapse they have a more detailed sequencing, the use of liquid biopsy for the diagnosis of a patient… All these tasks They are organized into work packages.
Is there a defined line to apply what the project wants to promote on a day-to-day basis?
Antonio Perez-Martinez: We try to homogenize it, today it does not exist. There is still a significant gap between what has to be and what is. Scientific advances are going much faster than the regulatory part. In childhood cancer we have important limitations. There is few clinical trials, little evidence, recruitment difficulty… The real impact of personalized medicine on childhood cancer is minor. That does not mean that there are not patients who can benefit. The first step is that all patients have access to an advanced diagnosis of their tumor. This may change your treatment. Our responsibility as a scientific society is that regulatory agencies allow access to drugs to be modified, allowing better qualities of healing. It is still a way we have to go.
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“The real impact on childhood cancer is minor” |
Will there be a paradigm shift in the treatment and monitoring of childhood cancer?
Lucas Moreno: Drugs in Pediatrics cost to be available, few are arriving. Our patients today are cured in a high proportion, but there is also a high number of sequelae that they have to suffer throughout their lives. The new drugs that are becoming available have much less toxicity and we continue to monitor them to see them in the long term. We seek to introduce immunotherapies to improve patient survival. We want to avoid treatments with a lot of long-term toxicity, such as chemotherapy.
What are the pillars of the national strategy in personalized medicine to address pediatric cancer?
Antonio Perez-Martinez: The cornerstone for now has to be the scientific societies, trying to make it universal, identifying the different groups as different competencies. At the organizational-care level we cannot modify the system. Most of us professionals who work with rare diseases such as childhood cancers would like much more centralized clinical care in national reference centers. Bringing together clinical experience in all areas accelerates knowledge. The current system makes it difficult for that to change. It is not a realistic aspiration that in the coming years there will be 5 childhood cancer centers in Spain.
With the centers that currently exist, we can establish resource management and identify centers with different competencies that can host other centers in their network. We are looking for a great unit to integrate them all, allowing us to heal more children and heal them better. We want to be at the same level both in absolute numbers, but also to reduce the consequences that pediatric survivors may have as adults.
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“It is not a realistic aspiration that in the coming years we will have 5 childhood cancer centers in Spain” |
How many boys and girls will be treated?
Lucas Moreno: The philosophy of this project is that it reaches all the people in Spain who suffer from childhood cancer. There are some hospitals that incorporate sequencing into your routine, others are halfway through and some are just beginning. If in Spain there are 1,200 children with cancer every year, the philosophy is that the studies are made available to all patients who may need them. We still need to define the groups most at risk, but we want to reach everyone.
Is rapid progress being made against childhood cancer at the research level?
Lucas Moreno: We are moving forward and the speed is enormous. There are currently advances in clinical trials and basic research. Despite this, we cannot have a satisfactory message. Today almost every week a patient dies or relapses. It is unacceptable that there is still so much way to go. You can go faster and get more options to patients sooner.
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