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New Treatments Aim To Save Kids' Eyes
Doctor: Suicide Gene Therapy, Proton Beam Radiation Can Kill Eye Cancer, Offer Alternative To Removal
This devastating eye cancer can lead children into a world of darkness. When kids survive retinoblastoma -- a cancer that develops in the retina -- 97-percent live with a moderate to severe visual impairment. A new effort is focused on finding treatments that can save these kids and their eyesight.Angela Van Beveren saw the cancer in her daughter's eye when she was only a few weeks old. It appeared as a strange glow in Leah's left eye."It just seemed like something was not right," Van Beveren said.
The tumors were retinoblastoma. Within a year, doctors had to remove her eye to stop the cancer."At which point, I completely lost it, thinking of my little girl with no eye," Van Beveren said.Today, Leah is a happy 6-year-old, with a prosthesis she calls her "hero eye" -- because it saved her life.But researchers are working on new treatments to kill the cancer before a child's eye has to be removed.The first is called "suicide gene therapy." Doctors inject viral particles into the eye then follow it up with a powerful IV drug. The combination launches an all-out attack on tumor cells."The product is poisonous to the cell, and the cell eventually dies because of that," said Dr. Murali Chintagumpala, a pediatric oncologist at the Retinoblastoma Center of Houston in Texas.The second new therapy is proton beam radiation, a more precise treatment that targets only the tumor."We will be able to spare the normal tissues around the eye from the effects of radiation therapy, thereby reducing long-term side effects including future cancers," Chintagumpala said.Leah's now celebrating five years cancer-free.For kids whose cancer is stopped in the eye, the cure rate is 95 percent. It's unclear exactly what causes retinoblastoma, though 30 to 40 percent of cases are hereditary. In kids with retinoblastoma, it's common for a camera flash to produce the appearance of a white pupil in photos. The American Academy of Ophthalmology said if this is the case, take your child to an eye doctor immediately.BACKGROUND: Retinoblastoma is an eye cancer that affects approximately 1 in 18,000 children younger than age 5. It's the most common malignant tumor of the eye that occurs in children, according to Texas Children's Cancer Center. Although the cancer typically affects one eye, in 20 to 30 percent of cases, it affects both eyes. The disease can be either hereditary or non-hereditary. Children with retinoblastoma in both eyes and about 15 percent of patients with the cancer in one eye have the hereditary form, which is caused by an inactivated retinoblastoma gene in all the cells of the body. The hereditary form of retinoblastoma causes multiple tumors in both eyes, while the non-hereditary form causes a single tumor in one eye.SYMPTOMS: The National Cancer Institute says you should take your child to the doctor to be screened for retinoblastoma if any of the following occur: the pupil of the eye appears white instead of red when light -- such as a camera flash -- shines into it; the eyes appear to be looking in different directions; or the child complains of pain or redness in the eye.TREATMENT: As long as retinoblastoma hasn't spread beyond the eye, cure can be achieved in more than 90 percent of children by removing the affected eye, called enucleation. Radiation therapy may be used instead of enucleation. This type of treatment involves using high-energy X-rays or other types of radiation to kill cancer cells or stop them from growing. Doctors say one of the problems with radiation treatment for retinoblastoma is children younger than 1 are put at higher at risk for developing cancers later on in life. Radiation treatment of the eye also leads to deformation of the walls of the eye so that it doesn't grow normally. One type of radiation that avoids these complications is proton beam radiation, in which protons are used to target cancer cells through a special machine. "With this specific proton beam radiation therapy, we will be able to target just the tumor, the lining of the eyeball, from which arises this tumor, and we will be able to spare the normal tissues around the eye from the effects of radiation therapy, thereby reducing long-term side effects including future cancers," Chintagumpala said.SUICIDE GENE THERAPY: This new treatment option for retinoblastoma is suicide gene therapy, which involves injecting viruses into the eye near the cancer and then administering an antiviral drug called ganciclovir via IV twice a day for a week. "When it’s injected into the eye, the tumor cells take up these viral particles, and these viral particles contain an enzyme which metabolizes the drug that we inject through the vein subsequently, and the product is poisonous to the cell, and the cell eventually dies because of that," Chintagumpala said. The gene therapy treatment may be repeated up to four times depending on how the patient responds.
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