In a first, Bai Jerbai Wadia Hospital for Children successfully treated a 3.5-year-old baby Diya from Mumbai with Dinutuximab Immunotherapy for neuroblastoma, a type of cancer that starts in the nerve cells. It is an immunotherapeutic agent used in combination with other immunomodulating agents to tackle high-risk neuroblastoma in pediatric patients and improve the outcome of this cancer. She was the first patient to get this immunotherapy on a compassionate basis. Currently, the patient is in remission and recovering very well.
A couple Rajesh Deoji Gala and Kalpana Gala from Andheri, Mumbai were happy with the birth of their second child Diya. Their happiness didn’t last for too long as the baby would cry profusely due to constant abdominal pain at 2.5 years of age in July 2020 and became fragile. Her parents panicked and took her to a local doctor who administered medicines that gave her relief for time being. Since pain did not subside, her parents took her to a specialist who performed sonography and other tests that confirmed stage IV high-risk neuroblastoma. Even after taking the standard treatment of this cancer, Diya’s chances of complete cure were 30 to 40%. However, the patient was admitted to Wadia Hospital wherein Dinutuximab Immunotherapy was administered to improve her chance of long-term cure.
Dr. Prashant Hiwarkar, a bone marrow transplant physician at Wadia Hospital said, “Diya presented to B.J. Wadia hospital with non-resolving abdominal pain. An ultrasound showed a mass in her abdomen and a battery of tests later shattered her parents’ world. Diya was diagnosed with metastatic neuroblastoma. It is cancer that starts in a very early form of nerve cells and occurs in young children. It is the second most common solid tumor in childhood with high-risk neuroblastoma having one of the worst prognoses amongst childhood cancers. It is a type of cancer that begins in immature nerve tissue present in the adrenal glands, neck, chest, or spinal cord. The disease is mainly seen in children less than five years, and the symptoms are bone pain and a lump in the abdomen area, neck, or chest. Metastatic neuroblastoma can come back even after aggressive therapy. In India, these children get treated with a conglomerate of therapy involving chemotherapy, surgery, autologous stem cell transplant followed by radiotherapy. Despite all this, only 40 out of 100 children survive long term.”
Dr. Hiwarkar added, “A year after the diagnosis, she was given Dinutuximab, one of the new generations of medications called immunotherapy that we are using at our center to treat patients above 1 year. It is approved by The U.S. Food and Drug Administration (FDA) and used for those patients whose condition hasn’t improved due to the standard cancer treatment. It is becoming the standard approach of therapy for this type of cancer. The drug can be administered as an infusion into a vein for around ten days every 35 days as one course, up to a maximum of 5 courses.”
Dinutuximab is an antibody therapy, a form of immunotherapy. The antibody acts against a sugar-fat molecule present on nearly all neuroblastoma cells (GD2). When the antibody binds to GD2 on the neuroblastoma cells, the cells die in a different way than after chemotherapy or radiotherapy. “Autologous stem cell transplant improves the outcome marginally in this case but the addition of monoclonal antibody-like Dinutuximab beta improves the disease-free survival to 60%,” said Dr. Hiwarkar.
“Diya is the first patient in the country to receive this drug on a compassionate basis. At Wadia Hospital, we believe in providing world-class services to children from every section of society regardless of their socio-economic background. The hospital has access to another monoclonal antibody (Blinatumomab) used for relapsed or refractory B cell acute lymphoblastic leukemia, a kind of blood cancer. Three children with pediatric leukemia have been treated with Blinatumomab, and all 3 have gone into remission. Two children have successfully undergone a stem cell transplant and one will be transplanted soon,” said Dr. Minnie Bodhanwala, CEO of Wadia Hospital.
Dr. Bodhanwala added, “Our transplant unit has been able to go beyond the traditional mould of pediatric transplants in the country to also focus on difficult to cure diseases like relapse and refractory leukemias, primary immunodeficiencies, and children with bone marrow failure syndromes with severe infections. B.J. Wadia Hospital for Children has a 93% success rate for children with primary immunodeficiencies, a rare group of disorders with the best outcome in the country. We have assisted several patients to source drugs on a compassionate basis to give these children the best possible chance at a cure.”
“Neuroblastoma is a completely unknown entity for us. Our world came crashing down after the cancer diagnosis. We were shocked on hearing the word cancer and appalled to see her cry in pain. My wife and I spent sleepless nights thinking about how to manage the treatment as I work in general stores and we live from hand to mouth. We thought her suffering would never end. We took the help of various platforms for raising funds for her initial treatment. But, we want to thank Wadia Hospital who successfully started the treatment with a novel drug. Our daughter was treated with immunotherapy on a compassionate basis. I also thank my wife who gave me strength and support. My wife was my strength during the gloomy times. Over last year, Diya had to make continuous trips to the hospital and spent around 8 months in the hospital. Since there was Covid lockdown, the past 1 year was very challenging for us. Now, my baby is 3.5 years old now and slowly getting back on track. She has completed the first course of Dinutuximab and will get admitted for the second course after 35 days. Her treatment will be completed after 5 courses,” concluded Diya’s elated father Rajesh Deoji Gala.