Abstract
Cancer is a leading cause of death in both adults and children, but in terms of absolute numbers, pediatric cancer is a relatively rare disease. The rarity of pediatric cancer is consistent with our current understanding of how adult malignancies form, emphasizing the view of cancer as a genetic disease caused by the accumulation and selection of unrepaired mutations over time. However, considering those children who develop cancer merely as stochastically “unlucky” does not fully explain the underlying aetiology, which is distinct from that observed in adults. Here, we discuss the differences in cancer genetics, distribution, and microenvironment between adult and pediatric cancers and argue that pediatric tumours need to be seen as a distinct subset with their own distinct therapeutic challenges. While in adults, the benefit of any treatment should outweigh mostly short-term complications, potential long-term effects have a much stronger impact in children. In addition, clinical trials must cope with low participant numbers when evaluating novel treatment strategies, which need to address the specific requirements of children.
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Acknowledgments
NK, RF, and HS would like to acknowledge the support from the Master Course in Molecular Medicine at Ulm University, on which, during their time as students, the initial idea for this review was conceived. Sara E. Barry kindly read an early version of the manuscript and gave invaluable suggestions. MAW and KMD are, as always, grateful for the administrative support of Bianca Welz and Elke Lützner, as well as the support from the Förderkreis für tumour- und leukämiekranke Kinder Ulm e.V. Vicariously for all the pediatric patients seen in our clinics, the authors would like to dedicate this paper to Kilian Schlabach and his parents. We learn so much more about courage and the human spirit from these families than one could ever have imagined.
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Mike-Andrew Westhoff and Klaus-Michael Debatin shared seniority.
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Kattner, P., Strobel, H., Khoshnevis, N. et al. Compare and contrast: pediatric cancer versus adult malignancies. Cancer Metastasis Rev 38, 673–682 (2019). https://doi.org/10.1007/s10555-019-09836-y
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DOI: https://doi.org/10.1007/s10555-019-09836-y