High-risk neuroblastoma: lines of therapy
6 standard-of-care settings across 4 lines and 3 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
| Line | All comers | FRα | HR-positive |
|---|---|---|---|
| Advanced, first line | 1 | · | · |
| Third line and beyond | · | 1 | · |
| Special situations | · | · | 1 |
| Other settings | 3 | · | · |
Advanced, first line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Induction | Five or six cycles of cyclophosphamide-topotecan, cisplatin-etoposide and cyclophosphamide-doxorubicin-vincristine (COG) or rapid COJEC (SIOPEN); iodine-131 MIBG and, for ALK-mutant disease, lorlatinib within ANBL1531; surgery after induction. | NCI PDQ: Neuroblastoma Treatment (health professional version) | 85 |
Third line and beyond
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| FRα | Relapsed or refractory | Irinotecan-temozolomide with dinutuximab (ANBL1221) or naxitamab with GM-CSF; iodine-131 MIBG for avid disease; lorlatinib for ALK-mutant disease; GD2 CAR T-cells in trials. | NCI PDQ: Neuroblastoma Treatment (health professional version) | 89 |
Special situations
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| HR-positive | Survivorship | Hearing, cardiac, renal, endocrine, fertility and second-cancer follow-up for life. | NCI PDQ: Neuroblastoma Treatment (health professional version) | 79 |
Other settings
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Consolidation | Busulfan-melphalan (HR-NBL1) or tandem thiotepa-cyclophosphamide then carboplatin-etoposide-melphalan (ANBL0532) with autologous stem cell rescue. | NCI PDQ: Neuroblastoma Treatment (health professional version) | 87 | |
| All comers | Local control | Radiotherapy to the primary site bed and residual MIBG-avid metastases after transplant. | NCI PDQ: Neuroblastoma Treatment (health professional version) | 93 | |
| All comers | Post-consolidation | Dinutuximab with GM-CSF and isotretinoin for five cycles (ANBL0032; interleukin-2 dropped after HR-NBL1), then two years of eflornithine maintenance. | NCI PDQ: Neuroblastoma Treatment (health professional version) | 86 |
Sequence and caution pairings
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.