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Hematology/Oncology

Personalized Cancer Care

The Personalized Cancer Care Program at Floating Hospital for Children in Boston, MA is focused on improving outcomes for pediatric patients with cancer by using the very latest in targeted cancer therapies. We also aim to further the field of oncology by combining our knowledge of metronomic chemotherapy with currently available targeted drugs. 

Our Care Model

We are able to provide these innovative pediatric cancer therapies because there is more genetic and biologic information available than ever before. We use these resources in a systems approach to modify how tumors grow. It also means that the creation of your child’s treatment plan is based specifically on the markers found in your child’s tumor, not based on the location or body part where the tumor has been found.

We do this by designing a tailored treatment plan for your child using a combination of currently available drugs that are targeted to the tumor characteristics. We pair these drugs with low continuous doses of chemotherapy which kills the cancer cells by making the microenvironment unfriendly and “starving the cancer cells”. This minimizes side-effects while maintaining your child’s response to his or her cancer treatment. Every treatment plan we create is unique to each child, so no treatment plan is alike. 

The Personalized Cancer Care Program team at Floating Hospital believes that cancer is a chronic disease and we aim to control it while maintaining your child's quality of life. Typically, treatment is given in the outpatient clinic, reducing the need for multiple hospital admissions.

Check out a recent Channel 4 (CBS) story that highlighted Dr. Klement and this approach to treatment >

How it works

Our first step in developing your child’s individualized treatment plan is to use his or her tumor tissue to take a closer look at the tumor.

We start by doing a genomic analysis of the tumor tissue which helps us identify specific mutations that inhibit or promote tumor growth. We then do a proteomic (protein) analysis of the tumor tissue that identifies abnormal proteins that may inhibit or promote tumor growth.

Next, we do a pathway analysis for each of the genes/proteins that we found. Molecular pathways are where proteins interact with each other, generating a signal that either activates or inhibits the growth of the cell. Analyzing these pathways is key in identifying the molecular markers involved in your child’s tumor progression.

Looking into the makeup of your child’s tumor allows us to select the precise targeted drugs that can inhibit the growth and avoid the spread of your child’s cancer. We combine these targeted therapies with repetitive, low doses of chemotherapy (metronomic chemotherapy) to modify the tumor microenvironment so that it would remain “unfriendly” to tumor growth.

A chart created by Floating Hospital for Children in Boston that shows how we formulate targeted treatment plans for pediatric cancer patients. 

Targeted vs. Chemotherapy

You most likely are already familiar with standard chemotherapy drugs but may not be as familiar with targeted drugs.

Standard chemotherapy is common for all tumor types and is delivered at maximum tolerated doses. It kills all rapidly dividing cells, with substantial side effects including damage to normal rapidly dividing tissues such as hair, intestines and bone marrow.

Targeted therapy on the other hand, is a type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells with less harm to normal cells. They are carefully chosen to inhibit or activate specific molecular pathways.  Because the damage is limited to tumor tissue, targeted therapies may have fewer side effects than other cancer treatments.

The most common types of targeted therapies are small molecule drugs, monoclonal antibodies and vaccines:

Small molecule drugs change the activity of tumor specific proteins and “normalize” the effect of molecular pathways. Because of their size, small molecule drugs can easily cross cell membranes and interfere with proteins inside and outside of cells.

  • Method: Usually an oral medication given at home
  • Drug examples include: Bosutinib (Bosulif), Nilotinib (Tasigna), Lapatinib (Tykerb) and Dasatinib (Sprycel)

Monoclonal antibodies (MoAbs) use humanized antibodies to interact with growth factor receptors on the surface of a cell. When these antibodies bind to a receptor, it prevents the activation of the molecular growth factor pathway.

  • Method: Usually given intravenously (IV) every 2-3 weeks
  • Drug examples include: Cetuximab (Erbitux), Panitumumab (Vectibix) and Bevacizumab (Avastin)

Our immune system doesn’t do a good job fighting cancer because it usually doesn’t recognize cancer as a foreign disease. Vaccines are used to reactivate your child’s immune system and help his or her body recognize that cancer cells are foreign, which tells his or her immune system to attack the tumor.

  • Method: Usually given as an upfront injection of activated immune cells. It may be repeated as necessary.
  • Drug examples include: Sipuleucel-T (Provenge)
Dr. Klement is the Chief of Pediatric Hematology Oncology at Floating Hospital for Children in Boston, MA.

Cancer Moonshot 2020

The Division of Pedi Hematology/Oncology is one of 10 founding members in a consortium aiming to to accelerate the potential of combination immunotherapy as the next-generation standard of care in cancer patients.

Learn more