Doing Battle With Cancer … in Preschool

Abigail Mendoza 1_RS2
Photo provided by the Mendoza family

Abigail with some of the beads she earned. Comer Children’s Hospital awarded her a bead for each medical procedure she underwent.


By Jennifer Martin

Abigail Mendoza has proven herself to be remarkably tough.

Starting at age 3, the Chicago girl entered a cycle of cancer treatments that included chemotherapy, 12 radiation sessions, two surgeries, a stem cell transplant and more than 40 blood and platelet transfusions. Yet four years later, she remains a cheerful sprite and a straight-A student.

Abigail knows her medical treatments were designed to conquer her cancer but not her spirit.

“She had a miraculous, aggressive treatment plan that literally saved her life,” said her mother, Judy Mendoza.

Abigail, a patient at Comer Children’s Hospital at the University of Chicago, was diagnosed as a preschooler with neuroblastoma, the most common solid cancer in childhood that occurs outside of the brain or head. The tumor started in her right adrenal gland, above the kidney.

“In cases like Abigail’s, the tumor is difficult to cure because of its biological makeup,” said Susan Cohn, MD, professor of pediatrics at Comer Children’s Hospital. “Abigail had, at best, a 40 percent chance.”

But neither Cohn nor Abigail and her parents would give up. After six months of treatment, including six cycles of chemotherapy to wear down the stubborn tumor, Abigail’s disease was in remission in August 2007. In hopes of protecting her even further, Cohn told the Mendozas about a pediatric cooperative group clinical trial designed to prevent the recurrence of neuroblastoma for patients like Abigail — those with no detectable disease following a stem cell transplant. Abigail was soon enrolled.

A control group of children received a standard treatment of retinoic acid – vitamin A – which had already been shown in a previous clinical study to keep neuroblastoma at bay in some patients.

A second group received retinoic acid plus ch14.18, or the chimeric anti-GD2 monoclonal antibody plus proteins, called cytokines, that stimulate the immune system. Part mouse and part human, the ch14.18 molecule was designed to bind to certain antigens, or markers, on neuroblastoma cells.

“The experimental treatment was designed to stimulate the patient’s immune system to destroy any residual neuroblastoma cells,” explained Cohn, who was conducting the trial at Comer Children’s Hospital and served on the study’s research committee. Comer Children’s Hospital is a member of the Children’s Oncology Group (COG), a worldwide cooperative group that conducts clinical trials on childhood cancers. Cohn was chair of the COG’s Neuroblastoma Disease Committee when the study was developed.

Randomly selected for group two, Abigail spent another six months in and out of the hospital, receiving infusions. Then, once again, she returned home.

A few months later, Cohn called the Mendozas with startling news. After 10 years, the study had been halted because the children in group two were showing dramatically better results. At two years after treatment, they showed an event-free survival rate – that is, survival without a recurrence of cancer – of about 66 percent. Children from group one, who received only retinoic acid, showed an event-free survival rate of about 46 percent.

“The result was so exciting!  Event-free survival was improved by 20 percent!,” Cohn said. It was the biggest advance in neuroblastoma research in more than 10 years, she said.

The study was subsequently modified in order to give the antibody treatment to patients initially randomized to group one. “We now consider immunotherapy as part of our standard of care for children like Abigail,” Cohn said.   

The New England Journal of Medicine published the study on September 30.  

Abigail, meanwhile, has grown her hair back and spent the summer learning to swim. She plays softball, loves the singer Taylor Swift and enjoys hanging out with friends. Remembering her ordeal, she said she wasn’t scared, but “just wanted to feel better.”
 
Her return to an enjoyable life is not surprising to her nurse, Kelly Kramer, RN, MSN, CPON, CPNP. “She was a spunky little kid who wanted to be as normal as possible,” Kramer said. “I think that contributed to her healing process.”   
 
“She’s got a fighting spirit,” Judy Mendoza said. “If you didn’t know what she’d been through, you would never know she had cancer.”

Abigail Mendoza 2 Abigail Mendoza_Susan Kohn and Kelly Kramer_RS
Left:  Abigail (left), earlier this summer with her sister, Amanda. Now 7, Abigail is showing no signs of cancer. (Photo provided by the Mendoza family)

Right
: Abigail and her family benefited from the support and guidance of her nurse, Kelly Kramer, RN (left), and physician, Susan Cohn, MD, director of clinical research in pediatric hematology and oncology. (Photo by Dan Dry)