Infantile Neuroblastoma

Infantile neuroblastoma is a form of cancer that develops from immature nerve cells called neuroblasts. It usually occurs in children below the age of one year, though it can sometimes affect older children as well. While the exact cause of infantile neuroblastoma is unknown, certain genetic mutations are believed to contribute to its development. The symptoms of infantile neuroblastoma can vary depending on the location and size of the tumor. Common signs include a lump or mass in the abdomen, firmness or swelling in the affected area, and high blood pressure. Other symptoms may include fever, weight loss, irritability, and bone pain. However, it’s important to note that these symptoms can also be associated with other conditions, making it necessary to consult a healthcare professional for an accurate diagnosis.

Types

This type of cancer arises from immature nerve cells, known as neuroblasts, which typically develop into the adrenal glands located on top of the kidneys.

Ganglioneuroblastoma: Ganglioneuroblastoma is a type of infantile neuroblastoma that consists of a mixture of mature nerve cells (ganglion cells) and immature nerve cells (neuroblasts). This type of tumor is typically localized, meaning it does not spread to other parts of the body. Ganglioneuroblastomas are often detected in infants during routine physical examinations due to the presence of a palpable mass in the abdomen. Symptoms may include abdominal pain, distension, and constipation.
Neuroblastoma: Neuroblastoma is the most common and aggressive type of infantile neuroblastoma. It arises from undifferentiated neuroblasts and can occur anywhere along the sympathetic nervous system, most commonly in the adrenal glands. Neuroblastomas can rapidly grow and spread to other parts of the body, making early detection crucial for successful treatment. Symptoms may include a lump or mass in the abdomen, bone pain, and unexplained weight loss.
Ganglioneuroma: Ganglioneuroma is a benign form of infantile neuroblastoma, meaning it does not spread or invade nearby tissues. This type of tumor consists of mature ganglion cells and is usually asymptomatic. Ganglioneuromas are often discovered incidentally during imaging tests performed for unrelated reasons. They are typically slow-growing and have an excellent prognosis.
Nodular Ganglioneuroblastoma: Nodular ganglioneuroblastoma is a subtype of ganglioneuroblastoma that appears as distinct nodules within the tumor. This type is often found in older children and is associated with a more favorable prognosis compared to other types of neuroblastoma. Symptoms and treatment options for nodular ganglioneuroblastoma are similar to those of ganglioneuroblastoma.
Stage 4S Neuroblastoma: Stage 4S neuroblastoma is a unique subtype that occurs exclusively in infants under one year of age. It is characterized by tumor involvement in specific locations, such as the liver, skin, and bone marrow while sparing other parts of the body. Stage 4S neuroblastoma often regresses spontaneously without specific treatment, and the prognosis is generally favorable.

Causes

Understanding the potential causes of this condition is crucial for early detection and effective treatment. In this comprehensive guide, with possible causes of infantile neuroblastoma, sheds light on this complex condition.

Genetic Factors: Certain genetic abnormalities, such as mutations in the ALK gene or amplification of the MYCN gene, have been associated with infantile neuroblastoma. These gene alterations can contribute to the development of tumors.
Chromosomal Abnormalities: Changes in the structure or number of chromosomes, such as loss or gain of genetic material, can increase the risk of neuroblastoma. Chromosomal aberrations may be inherited or occur spontaneously.
Familial Predisposition: A small percentage of infants with neuroblastoma have a family history of the disease. In these cases, genetic factors inherited from parents or close relatives can play a significant role.
Maternal Factors: Certain maternal exposures during pregnancy, such as smoking, alcohol consumption, or drug use, have been linked to an increased risk of neuroblastoma in infants. These factors can impact fetal development and contribute to tumor formation.
Environmental Exposures: Exposure to environmental toxins, including pesticides, industrial chemicals, or radiation, may elevate the risk of neuroblastoma. Infants exposed to such substances may be more susceptible to developing the disease.
Birth Weight: Studies have suggested that infants with higher birth weights may have a slightly increased risk of neuroblastoma. However, the association between birth weight and the disease is not well understood and requires further research.
Age at Diagnosis: Neuroblastoma commonly affects children under the age of five, with the majority of cases diagnosed within the first year of life. The age at which the tumor is detected can influence the underlying causes and treatment approach.
Prematurity: Premature infants may have a slightly higher risk of developing neuroblastoma. The reasons behind this association remain uncertain and necessitate additional investigation.
Nerve Cell Development: Neuroblastoma arises from immature nerve cells, called neuroblasts. Disruptions in normal nerve cell development and maturation processes can contribute to tumor formation.
Neuroblastoma Genes: Various genes involved in neuroblastoma development, such as PHOX2B, have been identified. Mutations or alterations in these genes may disrupt normal cellular processes, leading to tumor growth.
Neural Crest Abnormalities: The neural crest, a group of cells critical for embryonic development, plays a role in neuroblastoma formation. Abnormalities during neural crest cell migration or differentiation can contribute to tumor development.
Epigenetic Modifications: Epigenetic changes, including alterations in DNA methylation or histone modifications, can influence gene expression patterns in neuroblastoma cells. These modifications may contribute to the initiation and progression of the disease.
Hormonal Factors: Certain hormones, such as catecholamines, which include adrenaline and noradrenaline, are involved in neuroblastoma growth and progression. Imbalances in hormonal regulation may contribute to tumor development.
Immune System Dysfunction: An impaired immune system may fail to recognize and eliminate cancerous cells, allowing neuroblastoma to proliferate. Genetic or environmental factors that compromise immune function could contribute to disease development.
Viral Infections: Some studies have suggested potential associations between neuroblastoma and viral infections, such as human herpesvirus 6 (HHV-6) or Epstein-Barr virus (EBV). However, the exact mechanisms linking these infections to neuroblastoma require further investigation.
Neuroblastoma in Twins: In rare cases, twins may both develop neuroblastoma. This occurrence suggests a genetic predisposition or shared environmental factors influencing disease development.
Neuroblastoma and Other Cancers: Certain genetic syndromes, such as Beckwith-Wiedemann syndrome or Li-Fraumeni syndrome, increase the risk of developing neuroblastoma along with other cancers. Understanding these syndromes can aid in early diagnosis and treatment.
Blood Vessel Abnormalities: Neuroblastoma tumors require a blood supply for growth. Abnormalities in blood vessel development or angiogenesis may facilitate tumor progression.
Prenatal Exposures: In utero exposure to certain substances, such as medications or chemicals, may affect fetal development and contribute to neuroblastoma formation. Identifying potential prenatal exposures is crucial for understanding disease etiology.
Disruptions in Cell Signaling Pathways: Aberrations in cellular signaling pathways, including the Notch, Hedgehog, or Wnt pathways, can promote neuroblastoma development. Targeting these pathways may offer potential therapeutic strategies.
Inflammation and Oxidative Stress: Chronic inflammation and oxidative stress have been implicated in various cancers, including neuroblastoma. These processes can damage DNA and promote tumor initiation and growth.
Neuroblastoma Stem Cells: Neuroblastoma stem cells possess self-renewal and differentiation capabilities, contributing to tumor heterogeneity and resistance to therapy. Targeting these cells is a focus of ongoing research.
Mitochondrial Dysfunction: Mitochondria, the energy-producing organelles in cells, play a crucial role in neuroblastoma biology. Dysfunctional mitochondria may contribute to tumor progression and treatment resistance.
Neurotrophic Factors: Neuroblastoma cells can produce and respond to neurotrophic factors, which promote cell survival and growth. Dysregulation of these factors can contribute to neuroblastoma development.
Dietary Factors: While no specific dietary factors have been definitively linked to neuroblastoma, a healthy diet rich in fruits, vegetables, and whole grains may reduce the risk of cancer overall.
Gut Microbiome: Emerging evidence suggests a potential link between the gut microbiome and cancer. Altered gut microbial composition in infancy could influence neuroblastoma susceptibility.
Immune System Development: The development and maturation of the immune system during infancy may affect the risk of neuroblastoma. Understanding the interplay between immune system development and disease onset is crucial.
Neuroblastoma and Pregnancy Complications: Certain complications during pregnancy, such as preeclampsia or gestational diabetes, have been associated with an increased risk of neuroblastoma. The underlying mechanisms require further investigation.
Hormonal Imbalances in Mothers: Maternal hormonal imbalances, such as excess estrogen or androgen levels, may impact fetal development and contribute to neuroblastoma formation.
Unknown Factors: Despite extensive research, the causes of infantile neuroblastoma remain unknown in many cases. Continued exploration and advancements in scientific understanding are necessary to unravel the underlying mechanisms.

Symptoms

Common symptoms of infantile neuroblastoma in a simplified manner, ensuring accessibility for everyone

Swelling or lump in the abdomen: Infantile neuroblastoma often manifests as a noticeable lump or swelling in the abdomen. This mass can be firm or soft to the touch and may cause discomfort.
Paleness: Children with neuroblastoma may appear pale, as the condition can lead to a decreased number of red blood cells, causing anemia.
Fatigue: Persistent tiredness or exhaustion is a symptom frequently associated with neuroblastoma. It may result from the body’s immune response to the tumor or from the cancer’s effect on the production of energy.
Loss of appetite: Infants with neuroblastoma may experience a reduced desire to eat. This symptom can lead to weight loss and slower growth.
Weight loss: Unexplained and significant weight loss can occur in children with neuroblastoma, causing a noticeable decrease in body weight over a short period.
Bone pain: Neuroblastoma may cause bone pain or discomfort, which can manifest as irritability, limping, or reluctance to bear weight.
Blueberry-muffin spots: These are small, purplish bumps on the skin that resemble blueberries. They occur due to the accumulation of cancer cells in the skin and are most commonly found on the head, neck, and upper body.
Proptosis (bulging of the eyes): One eye or both eyes may protrude from their sockets. This can be a sign that neuroblastoma has spread to the area behind the eyes.
Neurologic symptoms: Neuroblastoma can lead to various neurologic symptoms such as weakness, numbness, or difficulty controlling muscles. These symptoms may be localized or affect the entire body.
Swollen lymph nodes: Enlarged lymph nodes, particularly in the neck, may indicate the presence of neuroblastoma. These swollen nodes can be felt as lumps under the skin.
Uncontrolled movements: In some cases, neuroblastoma may cause involuntary movements, such as tremors or jerking motions.
Respiratory symptoms: Persistent cough, wheezing, or shortness of breath can occur when neuroblastoma affects the chest or compresses nearby structures.
Abnormal eye movements: Neuroblastoma can affect eye control and cause rapid, uncontrolled eye movements known as nystagmus.
Hypertension (high blood pressure): Neuroblastoma can lead to increased blood pressure, which may result in symptoms such as headaches, dizziness, or nosebleeds.
Flushing: Episodes of sudden and intense redness of the skin, often accompanied by warmth, can be a symptom of neuroblastoma.
Enlarged liver or spleen: The liver or spleen may become enlarged due to the presence of neuroblastoma, leading to abdominal discomfort or a feeling of fullness.
Sweating: Excessive sweating, especially at night, can be an indication of neuroblastoma. This symptom is often accompanied by fever.
Eye drooping or eyelid retraction: Neuroblastoma may affect the muscles that control the eyelids, causing one eyelid to droop or both eyelids to retract.
Constipation: Infants with neuroblastoma may experience difficulty passing stools regularly, leading to constipation.
General discomfort or irritability: Children with neuroblastoma may exhibit signs of overall discomfort or irritability without an apparent cause.

Diagnosis

Essential diagnosis and tests used in the detection and evaluation of infantile neuroblastoma.

Abdominal Ultrasound: Abdominal ultrasound is a painless imaging test that uses sound waves to create images of the abdominal area. It is commonly used as an initial screening tool to identify tumors in the abdomen, including neuroblastomas.
Computed Tomography (CT) Scan: CT scans combine X-ray images to create detailed cross-sectional images of the body. They help visualize the size, location, and spread of neuroblastomas, providing valuable information for diagnosis and treatment planning.
Magnetic Resonance Imaging (MRI): MRI uses powerful magnets and radio waves to produce detailed images of the body’s internal structures. It is especially useful in assessing the extent of neuroblastoma and detecting any involvement of nearby organs or tissues.
Metaiodobenzylguanidine (MIBG) Scan: MIBG scans involve injecting a radioactive substance that targets neuroblastoma cells. A special camera then captures images of the radioactive material, helping to identify the primary tumor and detect any metastases.
Bone Scan: Bone scans are conducted to determine if the neuroblastoma has spread to the bones. A small amount of radioactive material is injected, and a scanner detects the radioactivity, highlighting any areas of abnormal bone activity.
Positron Emission Tomography (PET) Scan: PET scans use a small amount of radioactive material to visualize metabolic activity within the body. They are useful in identifying neuroblastoma metastases and assessing the response to treatment.
Blood and Urine Tests: Blood and urine tests are performed to measure certain substances that may indicate the presence of neuroblastoma. These tests can help assess the overall health of the child and monitor the response to treatment.
Bone Marrow Aspiration and Biopsy: Bone marrow aspiration and biopsy involve the collection of bone marrow samples for examination. This test helps determine if the cancer has spread to the bone marrow, which is crucial for staging and treatment decisions.
Biopsy: A biopsy involves the removal of a tissue sample from the tumor for microscopic examination. It helps confirm the diagnosis of neuroblastoma and provides valuable information about its characteristics and aggressiveness.
Genetic Testing: Genetic testing is performed to identify specific genetic mutations associated with neuroblastoma. It helps in assessing the risk of developing the disease and may guide personalized treatment approaches.
MYCN Amplification Testing: MYCN amplification testing is carried out to determine the presence of extra copies of the MYCN gene, which is associated with aggressive neuroblastomas. The results influence treatment decisions and prognosis.
Chromosomal Analysis: Chromosomal analysis involves examining the chromosomes in neuroblastoma cells for any abnormalities. Certain chromosomal changes can provide important prognostic information and guide treatment choices.
Immunohistochemistry: Immunohistochemistry involves using antibodies to detect specific proteins on neuroblastoma cells. This test helps classify the tumor and provides insights into its behavior and potential treatment options.
Flow Cytometry: Flow cytometry analyzes the characteristics of neuroblastoma cells, such as size, shape, and the presence of specific molecules on the cell surface. It aids in tumor classification and assessing treatment response.
Fluorescence In Situ Hybridization (FISH): FISH is a molecular technique used to detect specific DNA sequences in neuroblastoma cells. It helps identify chromosomal abnormalities and genetic changes associated with the disease.
Whole-Exome Sequencing (WES): WES involves sequencing the protein-coding regions of the genome. It can identify specific mutations that may be present in neuroblastoma cells, helping guide targeted therapies.
Circulating Tumor DNA (ctDNA) Analysis: ctDNA analysis involves the detection and analysis of tumor-specific DNA fragments circulating in the bloodstream. It can be used to monitor treatment response and detect disease recurrence.
Meta-analysis: Meta-analysis combines data from multiple studies to provide a comprehensive overview of neuroblastoma research. It helps identify trends, evaluate diagnostic methods, and improve overall understanding.
Histopathology: Histopathology involves examining tumor tissue under a microscope to study its cellular characteristics. This analysis helps determine the tumor’s type, grade, and extent of differentiation.
Immunophenotyping: Immunophenotyping uses antibodies to identify specific proteins expressed on the surface of neuroblastoma cells. This information aids in tumor classification and selecting targeted therapies.
Electromyography (EMG): EMG measures the electrical activity of muscles and nerves. It may be performed to assess the involvement of the nervous system in neuroblastoma cases with specific symptoms.
Electrocardiogram (ECG) and Echocardiogram: ECG and echocardiogram evaluate the heart’s electrical activity and structure, respectively. They are important for assessing cardiac function, particularly before and during certain neuroblastoma treatments.
Neurologic Evaluation: A comprehensive neurologic evaluation assesses the child’s nervous system, including reflexes, muscle strength, coordination, and sensory function. It helps determine the extent of neuroblastoma’s impact on neurological function.
Imaging of the Central Nervous System (CNS): Imaging techniques such as MRI or CT scan of the brain and spinal cord help evaluate the involvement of the central nervous system in neuroblastoma cases.
24-Hour Urinary Catecholamines and Metanephrines: Measuring the levels of catecholamines and metanephrines in a 24-hour urine sample can provide additional information about neuroblastoma and its response to treatment.
Lumbar Puncture: A lumbar puncture involves inserting a needle into the lower back to collect cerebrospinal fluid (CSF). It helps assess the involvement of the central nervous system and identify any tumor cells in the CSF.
Fetal Ultrasound: Fetal ultrasound is used during pregnancy to evaluate the fetus for signs of neuroblastoma. It can detect tumors or structural abnormalities that may indicate the presence of the disease.
Genetic Counseling: Genetic counseling involves discussing the risk of neuroblastoma recurrence or the presence of hereditary factors. It helps families understand the genetic implications and make informed decisions.
Follow-up Imaging: Regular follow-up imaging, such as ultrasound, CT scan, or MRI, helps monitor the tumor’s response to treatment, detect potential recurrence, and assess long-term outcomes.
Multi-Disciplinary Team Consultation: A multi-disciplinary team of healthcare professionals, including oncologists, surgeons, radiologists, pathologists, and nurses, collaborates to evaluate each case comprehensively and develop individualized treatment plans.

Treatment

It develops in the adrenal glands or nerve tissue near the spine, chest, abdomen, or pelvis. If your child has been diagnosed with infantile neuroblastoma, it’s crucial to explore various treatment options to ensure the best possible outcome.

Surgery: Surgery is often the first line of treatment for infantile neuroblastoma. It involves removing the tumor and any surrounding affected tissue. Surgical options include tumor excision, debulking, and resection. The extent of surgery depends on the size, location, and stage of the tumor.
Chemotherapy: Chemotherapy uses powerful drugs to kill cancer cells or slow down their growth. It is commonly used before or after surgery to shrink the tumor, destroy any remaining cancer cells, or reduce the risk of recurrence.
Radiation Therapy: Radiation therapy involves the use of high-energy X-rays or other forms of radiation to kill cancer cells. It is often used after surgery or as a standalone treatment to target and destroy remaining cancer cells.
Immunotherapy: Immunotherapy boosts the body’s immune system to fight against cancer cells. Monoclonal antibodies, checkpoint inhibitors, and cytokines are examples of immunotherapeutic agents that may be used to treat infantile neuroblastoma.
Stem Cell Transplantation: Stem cell transplantation, also known as a bone marrow transplant, involves replacing diseased or damaged bone marrow with healthy stem cells. This procedure helps restore the body’s ability to produce new blood cells after high-dose chemotherapy or radiation therapy.
Retinoid Therapy: Retinoids, such as isotretinoin and 13-cis-retinoic acid, are drugs derived from vitamin A. They are used as a maintenance therapy to prevent the recurrence of neuroblastoma after other treatments. Retinoids help differentiate neuroblastoma cells into more mature forms that are less likely to divide and spread.
Targeted Therapy: Targeted therapy uses drugs that specifically target cancer cells while causing minimal damage to healthy cells. Examples of targeted therapy for neuroblastoma include inhibitors of the ALK gene mutation, such as crizotinib and ceritinib.
MIBG Therapy: MIBG (metaiodobenzylguanidine) therapy involves injecting a radioactive substance that specifically targets and destroys neuroblastoma cells. It is administered intravenously and can be combined with other treatments.
High-Dose Chemotherapy with Stem Cell Rescue: High-dose chemotherapy involves using stronger chemotherapy drugs than conventional chemotherapy. Stem cells are collected from the patient or a donor before the treatment and then infused back into the patient after chemotherapy to replenish the bone marrow.
Watchful Waiting: In some cases, particularly for low-risk neuroblastoma, a “wait and watch” approach may be adopted. Regular monitoring of the tumor is done, and treatment is initiated only if there are signs of tumor growth or progression.
Radiofrequency Ablation: Radiofrequency ablation uses high-frequency electrical currents to heat and destroy cancer cells. This minimally invasive procedure is usually performed under image guidance.
Cryoablation: Cryoablation involves using extreme cold to freeze and destroy cancer cells. It is a minimally invasive procedure that can be effective for small tumors.
Embolization: Embolization involves blocking the blood supply to the tumor, thereby starving it of nutrients and oxygen. This procedure can be used to shrink the tumor before surgery or reduce symptoms caused by tumor growth.
Radioimmunotherapy: Radioimmunotherapy combines the use of radioactive substances and immunotherapy. Radioactive particles attached to antibodies are delivered to cancer cells, delivering a localized radiation dose while sparing healthy cells.
Proton Therapy: Proton therapy uses protons, rather than X-rays, to deliver radiation to the tumor. It allows for more precise targeting, reducing the radiation dose to surrounding healthy tissues.
Radiotherapy with I-131 MIBG: Radiotherapy with I-131 MIBG involves using radioactive iodine-131 MIBG to deliver targeted radiation to neuroblastoma cells. This treatment can be effective, especially if the tumor has spread to distant sites.
Antibody Therapy: Antibody therapy involves using antibodies designed to attach to specific molecules on cancer cells, marking them for destruction by the immune system. Antibody therapy can be used alone or in combination with other treatments.
Tyrosine Kinase Inhibitors (TKIs): TKIs are drugs that block the activity of enzymes called tyrosine kinases, which play a role in the growth of cancer cells. TKIs can help slow down or stop the growth of neuroblastoma cells.
Antiangiogenic Therapy: Angiogenesis is the process of forming new blood vessels. Antiangiogenic therapy aims to inhibit the growth of blood vessels that supply the tumor, thereby limiting its nutrient supply.
Stereotactic Radiosurgery: Stereotactic radiosurgery uses focused radiation beams to deliver a high dose of radiation to a specific area, such as a tumor, while minimizing radiation exposure to surrounding healthy tissues.
Thermal Ablation: Thermal ablation uses heat generated by various sources, such as laser or microwave, to destroy cancer cells. It is a minimally invasive treatment option.
Hormone Therapy: Hormone therapy may be used for neuroblastomas that have receptors for certain hormones. It involves blocking the effects of hormones that promote tumor growth.
Electrochemotherapy: Electrochemotherapy combines chemotherapy with the application of electrical pulses to enhance the absorption of chemotherapy drugs by cancer cells. This technique increases the effectiveness of chemotherapy.
Biologic Therapy: Biologic therapy uses substances derived from living organisms, such as vaccines or gene-modified cells, to stimulate the immune system and target cancer cells.
Anti-GD2 Antibody Therapy: Anti-GD2 antibody therapy involves using antibodies that specifically target GD2, a molecule found on neuroblastoma cells. It can be used in combination with other treatments.
Photodynamic Therapy: Photodynamic therapy uses a photosensitizing agent that, when activated by light, produces reactive oxygen species that destroy cancer cells. It is a localized treatment option.
Adoptive Cell Therapy: Adoptive cell therapy involves collecting and modifying the patient’s immune cells to enhance their ability to recognize and kill cancer cells. These modified cells are then reinfused into the patient.
Heat Therapy: Heat therapy, such as hyperthermia or thermotherapy, uses elevated temperatures to damage or destroy cancer cells. It can be used in combination with other treatments.
Alternative and Complementary Therapies: Some parents may explore alternative or complementary therapies, such as acupuncture, herbal remedies, or mind-body techniques. It’s essential to discuss these options with your child’s healthcare team to ensure they do not interfere with conventional treatments.
Palliative Care: Palliative care focuses on providing relief from symptoms and improving the quality of life for children with neuroblastoma. It aims to address physical, emotional, and psychological needs, both for the child and their family.

Medications

Drug Treatments for Infantile Neuroblastoma:

Cisplatin: Cisplatin is a chemotherapy drug that inhibits the growth of cancer cells by damaging their DNA.
Carboplatin: Similar to cisplatin, carboplatin also interferes with cancer cell DNA, impeding its growth.
Cyclophosphamide: Cyclophosphamide is an alkylating agent that disrupts the DNA of cancer cells, leading to their death.
Doxorubicin: Doxorubicin is a chemotherapy drug that inhibits DNA replication and causes cancer cell death.
Etoposide: Etoposide interferes with cancer cell DNA, preventing its ability to divide and grow.
Topotecan: Topotecan hampers DNA replication in cancer cells, reducing their proliferation.
Irinotecan: Irinotecan prevents DNA synthesis, inhibiting the growth of cancer cells.
Vinblastine: Vinblastine disrupts the formation of microtubules, essential for cell division, thereby hindering cancer cell growth.
Vincristine: Vincristine also disrupts microtubule formation, preventing cancer cell division.
Melphalan: Melphalan is an alkylating agent that interferes with cancer cell DNA, leading to its demise.
13-cis-Retinoic acid: 13-cis-retinoic acid is another retinoid that aids in cell differentiation and reduces cancer cell growth.
Busulfan: Busulfan is an alkylating agent that disrupts cancer cell DNA, impeding its replication.
Thiotepa: Thiotepa is an alkylating agent that interferes with cancer cell DNA, leading to its destruction.
Gemcitabine: Gemcitabine inhibits DNA synthesis, preventing cancer cells from dividing and growing.
Eribulin: Eribulin affects microtubule dynamics, hindering cancer cell division and growth.
Dinutuximab: Dinutuximab is an immunotherapy drug that targets neuroblastoma cells, activating the immune system to destroy them.
Nivolumab: Nivolumab is an immunotherapy drug that boosts the immune system to recognize and attack cancer cells.
Lomustine: Lomustine is an alkylating agent that damages cancer cell DNA, inhibiting its growth.
Bevacizumab: Bevacizumab is an angiogenesis inhibitor that blocks the formation of new blood vessels in tumors, impeding their growth.