Childhood cancer in Africa French African Pediatric Oncology Group experience Mhamed Harif CHU...
-
Upload
horace-kennedy -
Category
Documents
-
view
239 -
download
5
Transcript of Childhood cancer in Africa French African Pediatric Oncology Group experience Mhamed Harif CHU...
Childhood cancer in Africa
French African Pediatric
Oncology Group experience
Mhamed HarifCHU Mohammed VI, Marrakech, Morocco
Africa
Continent Size:
30,065,000 sq km
Population: 1,000,000,000 (2009)
< 15 years :→ 500 M. (2009)
More than 50 000 cancers expected in children each year
Pediatric oncology units in Africa
2000
GFAOP EN 2000
8 Unités pilotes
6 pays africains
Algerie : Algiers Oran
Cameroon : YaoundéMadagascar : AntananarivoMaroc : Rabat
CasablancaSenegal : DakarTunisie : Tunis
North Africa Tunisia 1 unit Algeria 2 units Morocco 2 units
West Africa Senegal 1 unit Ivory Coast 1 unit Mali 1 unit Burkina Faso 1 unit Togo 1 unit
Central Africa
Cameroon 1 unit Congo 1 unit
Madagascar Antananarivo 1 unit
13 Units
French Speaking Africa
Pediatric Oncology Units involved2010
French-African Paediatric Oncology Group
GFAOP
------- Created in April 2000 -------
Objective : • Improve the management of childhood cancer in Africa• Setting up a database of pediatric cancer in Africa
Methods :• Teaching and training• Improving access to care• Improving awareness regarding pediatric cancer• Developing adapted clinical research programs • Help local support
Teaching and training
Nurses Training in French units (2001 – 2008) : 30 South to South cooperation (Morocco) : 3 French nurses teaching in African Units : 4
Pathology lab. technicians PCD courses (Yaounde) : 3 French lab. (6 months stage) : 2
French-African Paediatric Oncology Group
GFAOP
Physicians
French National Diploma in PO(DIUOP) and 1 year hospital training
• 8 GFAOP members attended and succeeded Short 3 months training in Morocco
• 1 physician Workshops (1 to 3 ) at GFA meetings (1/year).
Teaching and training
French-African Paediatric Oncology Group
GFAOP
Therapeutic research
First study : 2001 – 2004 Objective : Protocol feasibility in “African medical
condition” 2 protocols : Wilms tumor and Burkitt lymphoma
• North Africa : almost unchanged SFCE or SIOP protocol• South to Sahara Units : ‘adapted’, less toxic
Second study : 2005 – 2008 Objectives :
• Improve the first results • Develop new protocols
3 new protocols : • Cyclophosphamide in Burkitt lymphoma• Acute lymphoblastic leukemia • Hodgkin disease
Nephroblastoma
First study : 2001 – 2004
Second study : 2005 – 2008
Nephroblastoma GFAOP STUDIES
GFAOP-Nephro 2001 : Protocol strategy Clinical examination
Abdominal USChest RX
Localized stage
4 x vincristine : 1,5 mg/m²2 x actino : 45 /kg
Metastatic stage
6 x vincristine : 1.5 mg/m²3 x actino : 50 mg/m²
Surgery + histologyStaging
Stage I : 2 courses
4 x vincristine : 1,5 mg/m²2 x actinomycine D : 45 /kg
Stage IV
SIOP 2001 schedule good respondersSurgery if needed
RadiotherapyIf necessary and available
Stage II and III
SIOP 2001
Patients inclusion
Nephroblastoma
GFAOP STUDIES
Study 1
1st april 2001 to 31st march 2004
Study 2
1st april 2005 to
31st march 2005
Patients registered 230 287 excluded at registration 39 51
included in the study 191 236excluded after surgery 29 73
Patients remaining in the study
161 163
Nephroblastoma GFAOP STUDIES
Patient Registration by Center
0
10
20
30
40
50
60
70
80
AbidjanAlger
BamakoCasa
DakarRabat
TanaTunis
Ouaga
Yaoundé
Etude 2001-2004
Etude 2005-2008
Nephroblastoma GFAOP STUDIES
Stage Distribution
24%22%
18% 34%2%
Stade 1 Stade 2 Stade 3
Stade 4 Unknown
8%27%11%
24% 30%
• Based on surgical and/or pathological reports
Study 1
Study 2
Nephroblastoma GFAOP STUDIES
Results :
All population
Nephroblastoma GFAOP STUDIES
GFAOP NEPHROBLASTOMA STUDY N° II OS and EFS ALL PATIENTS
154587177154384177
0,00
0,20
0,40
0,60
0,80
1,00
0 1 2 3
years post surgery
OS N=177
EFS N=177
At risk
85%
82%
GFAOP Nephroblastoma Study 1 O.S. and EFS All population 03/09
123649781041331235467398133
0,00
0,20
0,40
0,60
0,80
1,00
0 1 2 3 4 5
Years post surgery
OS n=133
EFS n=133
71%
69%
Risk
Results :
Comparison North Africa/
Sub Sahara units
Nephroblastoma GFAOP STUDIES
GFAOP NEPHROBLASTOMA STUDY N° I OS and EFS Maghreb and Sub Saharan
748610161832
0,00
0,20
0,40
0,60
0,80
1,00
0 1 2
years post surgery
OS Maghreb N=101
OS Sub Saharan N=32
58%
84%
At risk
GFAOP NEPHROBLASTOMA STUDY N° II OS Maghreb and Sub Saharan
386911771860
0,00
0,20
0,40
0,60
0,80
1,00
0 1 2
years post surgery
OS Maghreb N=117
OS Sub Sahara N=60
At risk
74%
90%
Burkitt Lymphoma
4 studies
Period I: LMB 89 modified protocols 2001-2004
• Burkitt-GFA 2001 • MAT(Morocco –Algeria –Tunisia)
Period II: 2005-2008
• Cyclo-Burkitt• MAT II(Morocco –Algeria – Tunisia)
Burkitt lymphomaGFAOP STUDIES
Burkitt-GFAOP 2001 protocol
COP COPM (course 1 and 2) CYM (course 3 and 4)
CyclophosphamideCPM : 300 mg/day IV
CPM500 mg/m²/day IV D1 to 3
Cytarabine 100mg/m²/day SC, D2 to 6
Vincristine1.5 mg/m² IV, D 1
Vincristine 2 mg/m² IV, D 1
MTX3 g/m² IV, D1
Prednisone60 mg/m² po, D 1 to 5
prednisone 60 mg/m² , D1 to 5
MTX + hydrocortisone: 15mg of each IT, day 2
Methotrexate (MTX)3 g/m² IV, D1
Cyt. 30 mg + Hc 15 mg IT, day 7
MTX + hydrocortisone (Hc)15mg of each IT, D2 and 6 Burkitt lymphoma
GFAOP STUDIES
Burkitt lymphoma : 2001 – 2004
343 patients enrolled ; included
306 Burkitt-GFAOP 2001 group : 187 MAT group : 119
Patients characteristics Age : 1- 17 years (Med : 6y) Sex ratio M/F : 1.9 Tumors main locations
• Abdominal : 242• Facial : 131 Burkitt lymphoma
GFAOP STUDIES
Burkitt lymphoma : 2001 – 2004
Burkitt lymphomaGFAOP STUDIES
M.H
arif
Ped
iatr
Blo
od C
ance
r 20
08;5
0:11
38–1
142
OS according treatment regimen
OS according to year of admission
Burkitt Lymphoma Second studies : 2005 – 2008
North Africa : MAT II protocol
Sub-Sahara units Cyclo-Burkitt GFAOP protocol
Burkitt lymphomaGFAOP STUDIES
Cyclo-Burkitt : Protocol strategy
CYLO BURKITT studyPatients sept 2009
12
93
12
6550
3113
18
12
18 46
24
0
20
40
60
80
100
120M
adagascar
Yaounde
Dakar
Bam
ako
Abid
jan
Ouagadougou
non included
cyclo B study
N : 254
Burkitt lymphomaGFAOP STUDIES
Cyclo –Burkitt : Staging
3%
15%
10%
72% Stage I
Stage II
Stage III
Stage IVBurkitt lymphomaGFAOP STUDIES
GFAOP CYCLO BURKITT2005 - 2009 OS - 254 pts
0,00
0,20
0,40
0,60
0,80
1,00
0 6 12 18 24 30 36months post dg
53%
Burkitt lymphomaGFAOP STUDIES
GFAOP CYCLO BURKITT2005 - 2009 O.S.
0,000,100,200,300,400,500,600,700,800,901,00
0 6 12 18 24 30 36months post dg
st I n= 23 pts st II n= 36 pts
st III n= 187 pts st IV n= 8 pts
81%
46%
GFAOP CYCLO BURKITT2005 - 2009 O.S.
0,000,100,200,300,400,500,600,700,800,901,00
0 6 12 18 24 30 36months post dg
st I n= 23 pts st II n= 36 pts
st III n= 187 pts st IV n= 8 pts
81%
46%
Burkitt lymphomaGFAOP STUDIES
MAT LMB 2005 protocol
Group A : 2 x COPAD
Group B : COP 2 x COPADM 2 x CYM
Group C : COP 2 x COPADM 2 x CYVE Seq 1, 2, 3, 4
Burkitt lymphomaGFAOP STUDIES
MAT LMB 2005 : inclusion
269 pts registered
34 excluded
235 included
209 eligible Burkitt lymphomaGFAOP STUDIES
Patient Registration by Center
Nb %
Algiers 24 10.21
Casablanca 68 28.93
Rabat 121 51.48
Tunis 22 9.36
Total 235 100
Burkitt lymphomaGFAOP STUDIES
GFAOP MAT 2 2005- 2009 study
11254869961382091122446587126209
0,00
0,20
0,40
0,60
0,80
1,00
0 6 12 18 24 30 36months post dg
Overall Survival
Event Free Survival
60%
at risk
Other programs
Hodgkin
ALL
Retinoblastoma
French-African Paediatric Oncology Group
GFAOP
HD-GFAOP protocol strategy
HD – GFAOP : first analyzes
Units participating : 5 Senegal, Madagascar, Mali, Cameroon, Ivory-Cost
Included : 30 Patients characteristics
Age : 2 - 20 years (Med : 9y 9m) Sex ratio M/F : 21/8 Stages :
• I/ II : 8• III : 18• IV : 4
Evaluated : 14 12 CCR 2 relapses
ALL - GFAOP protocol strategy
Induction5 weeks
Consolidation12 weeks
Intensification8 weeks
Maintenance18 months
PRD DXM ; VCR ; L Aspa
2 IT
PRD ; VCRMTX ; 6 MP
3 IT
DXM ; VCR Adria ; 6 MP ; Ara C
2 IT
6 MP ; MTX9 IT
ALL – GFAOP : first analyzes
4 Units : Cameroon, Madagascar Mali, Senegal
50 patients enrolled 38 confirmed and included32 eligible
24 CR (80%) 3 relapses 8 deaths (4 early deaths)
Conclusion
Multicentric and prospecive studies feasible in Africa
Depending on the site : Easier in the North Supportive care is improving XRT missing in the South
Results improving year after year
Challenges
• Tackling abandonment: Information, support for the families, improvement of access to care
• Tackling diagnostic delay
• Improving supportive care
• Ethics
• Data management
• Expanding activity to other cancers,
• Expanding activity to other regions and countries
Groupe Franco-Africain d’Oncology Pediatric