Skip to content
Triangle logo TriangleGet started
← Study library

NCT02176967 · CITED IN SOURCE DOCUMENTS

Response and Biology-Based Risk Factor-Guided Therapy in Treating Younger Patients With Non-high Risk Neuroblastoma

An NCI or FDA source cites this study. A citation does not establish that it applies to an individual diagnosis.

Phase
PHASE3
Status at capture
ACTIVE NOT RECRUITING
Registry last update
2026-08-25

This phase III trial studies how well response and biology-based risk factor-guided therapy works in treating younger patients with non-high risk neuroblastoma. Sometimes a tumor may not need treatment until it progresses. In this case, observation may be sufficient. Measuring biomarkers in tumor cells may help plan when effective treatment is necessary and what the best treatment is. Response and biology-based risk factor-guided therapy may be effective in treating patients with non-high risk neuroblastoma and may help to avoid some of the risks and side effects related to standard treatment.

Open the original ClinicalTrials.gov record → · Download preserved record

What did the study report?

Outcomes, safety and baseline populations are separate source sections. Quality-of-life measures appear under their original outcome titles.

No posted result sections were captured. Registered plans do not establish that a treatment works.

Who could take part
eligibility Criteria
Inclusion Criteria: * Patients must be: * \< 12 months (\< 365 days) of age at diagnosis with INRG stage L1; or * \< 18 months (\< 547 days) of age at diagnosis with INRG stage L2 or stage Ms neuroblastoma/ganglioneuroblastoma * Enrollment on ANBL00B1 or APEC14B1 is required for all newly diagnosed patients * Patients must have newly diagnosed v-myc avian myelocytomatosis viral oncogene neuroblastoma derived homolog (MYCN) non-amplified neuroblastoma (International Classification of Diseases for Oncology \[ICD-O\] morphology 9500/3) or MYCN non-amplified ganglioneuroblastoma verified by histology * Patients must meet the specified criteria for one of the treatment groups defined below; genomic features include MYCN gene amplification, segmental chromosome aberrations (somatic copy number loss at 1p, 3p, 4p, or 11q or somatic copy number gain at 1q, 2p, or 17q) and deoxyribonucleic acid (DNA) index * "Favorable" genomic features are defined by one or more whole-chromosome gains or hyperdiploid tumor (DNA index \> 1) in the absence of segmental chromosome aberrations as defined above * "Unfavorable" genomic features are defined by the presence of any segmental chromosome aberration (somatic copy number loss at 1p, 3p, 4p, or 11q or somatic copy number gain at 1q, 2p, or 17q) or diploid tumor (DNA index = 1); this includes copy neutral loss of heterozygosity (LOH) * Only patients with MYCN non-amplified tumors are eligible for this study * Group A: patients \< 12 months (\< 365 days) of age with newly diagnosed INRG stage L1 neuroblastoma/ganglioneuroblastoma who meet the following criteria: * Greatest tumor diameter \< 5 cm of adrenal or non-adrenal origin * Patients with non-adrenal primaries are eligible, but must have positive uptake on metaiodobenzylguanidine (MIBG) scan or elevated catecholamine metabolites (urine or serum) to support the diagnosis of neuroblastoma * No prior tumor resection or biopsy * Group A will be further split into two subsets, which are mutually exclusive, for statistical purposes * Group A1: * \> 6 months and \< 12 months of age with an adrenal primary tumor \< 5 cm in greatest diameter OR * Patients less than 6 months of age with an adrenal primary tumor \> 3.1 and \< 5 cm in greatest diameter OR * \< 12 months of age with a non-adrenal primary site \< 5 cm in greatest diameter * Group A2: =\< 6 months of age with an adrenal primary site and tumor =\< 3.1 cm in greatest diameter * Group B: patients \< 18 months (\< 547 days) of age with newly diagnosed INRG stage L2 neuroblastoma/ganglioneuroblastoma who meet the following criteria: * No life threatening symptoms or no impending neurologic or other organ function compromise (e.g. epidural or intraspinal tumors with existing or impending neurologic impairment, periorbital or calvarial-based lesions with existing or impending cranial nerve impairment, anatomic or mechanical compromise of critical organ function by tumor \[abdominal compartment syndrome, urinary obstruction, etc.\]); horner syndrome is not considered neurologic compromise * No prior tumor resection, tumor biopsy ONLY * Only patients with both favorable histology and favorable genomic features will remain on study as part of Group B; the institution will be notified of histologic and genomic results within 3 weeks of specimen submission on ANBL00B1 or APEC14B1 * Group C: patients \< 18 months (\< 547 days) of age with newly diagnosed INRG stage Ms neuroblastoma/ganglioneuroblastoma * No prior radiotherapy or chemotherapy, with the exception of dexamethasone, which is allowed * All patients and/or their parents or legal guardians must sign a written informed consent * All institutional, Food and Drug Administration (FDA), and National Cancer Institute (NCI) requirements for human studies must be met Exclusion Criteria: * Patients with MYCN amplified tumors are not eligible * Group B and C patients who do not enroll on ANBL1232 within 4 weeks of definitive diagnostic procedure * Group A and C patients, not required to undergo tumor biopsy, who do not enroll on ANBL1232 within 4 weeks of confirmatory imaging study
healthy Volunteers
false
maximum Age
18 Months
sex
ALL
std Ages
  1. CHILD
Treatment arms and interventions
arm Groups
  1. description
    Patients undergo clinical observation for 96 weeks in the absence of disease progression. Patients also undergo CT, MRI, and/or ultrasound throughout the trial.
    intervention Names
    1. Other: Clinical Observation
    2. Procedure: Computed Tomography
    3. Procedure: Magnetic Resonance Imaging
    4. Procedure: Ultrasound
    label
    Group A (clinical observation)
    type
    EXPERIMENTAL
  2. description
    Patients undergo clinical observation for 3 years in the absence of disease progression. Upon disease progression, patients undergo surgery or receive first-line chemotherapy comprising carboplatin IV over 1 hour on day 1 (courses 1, 2, 4, 6, and 7), etoposide IV over 1 hour on days 1-3 (courses 1, 3, 4, 5, and 7), cyclophosphamide IV over 1 hour on day 1 (courses 2, 3, 5, 6, and 8), and doxorubicin hydrochloride IV over 15 minutes on day 1 (courses 2, 4, 6 and 8). Treatment with chemotherapy repeats every 21 days for 2-8 courses in the absence of disease progression or unacceptable toxicity. Once a PR or better is achieved, patients undergo clinical observation for 3 years. Patients also undergo CT, MRI, and/or ultrasound throughout the trial and undergo bone marrow aspiration, bone marrow biopsy, and tumor biopsy at screening and time of progression.
    intervention Names
    1. Procedure: Biopsy
    2. Procedure: Bone Marrow Aspiration
    3. Procedure: Bone Marrow Biopsy
    4. Drug: Carboplatin
    5. Other: Clinical Observation
    6. Procedure: Computed Tomography
    7. Drug: Cyclophosphamide
    8. Drug: Doxorubicin Hydrochloride
    9. Drug: Etoposide
    10. Procedure: Magnetic Resonance Imaging
    11. Procedure: Ultrasound
    label
    Group B (clinical observation, first-line chemotherapy)
    type
    EXPERIMENTAL
  3. description
    Patients at high risk for deterioration and a poor outcome immediately receive first-line chemotherapy as in Group B. All other patients undergo clinical observation for 3 years in the absence of disease progression. Upon disease progression, patients receive first-line chemotherapy as in Group B. Once a PR or better is achieved, patients undergo clinical observation for 3 years. Patients also undergo CT, MRI, and/or ultrasound throughout the trial and undergo bone marrow aspiration, bone marrow biopsy, and tumor biopsy at screening and time of progression.
    intervention Names
    1. Procedure: Biopsy
    2. Procedure: Bone Marrow Aspiration
    3. Procedure: Bone Marrow Biopsy
    4. Drug: Carboplatin
    5. Other: Clinical Observation
    6. Procedure: Computed Tomography
    7. Drug: Cyclophosphamide
    8. Drug: Doxorubicin Hydrochloride
    9. Drug: Etoposide
    10. Procedure: Magnetic Resonance Imaging
    11. Procedure: Ultrasound
    label
    Group C (clinical observation, first-line chemotherapy)
    type
    EXPERIMENTAL
interventions
  1. arm Group Labels
    1. Group B (clinical observation, first-line chemotherapy)
    2. Group C (clinical observation, first-line chemotherapy)
    description
    Undergo biopsy
    name
    Biopsy
    other Names
    1. BIOPSY_TYPE
    2. Bx
    type
    PROCEDURE
  2. arm Group Labels
    1. Group B (clinical observation, first-line chemotherapy)
    2. Group C (clinical observation, first-line chemotherapy)
    description
    Undergo bone marrow aspiration
    name
    Bone Marrow Aspiration
    type
    PROCEDURE
  3. arm Group Labels
    1. Group B (clinical observation, first-line chemotherapy)
    2. Group C (clinical observation, first-line chemotherapy)
    description
    Undergo bone marrow biopsy
    name
    Bone Marrow Biopsy
    other Names
    1. Biopsy of Bone Marrow
    2. Biopsy, Bone Marrow
    type
    PROCEDURE
  4. arm Group Labels
    1. Group B (clinical observation, first-line chemotherapy)
    2. Group C (clinical observation, first-line chemotherapy)
    description
    Given IV
    name
    Carboplatin
    other Names
    1. Blastocarb
    2. Carboplat
    3. Carboplatin Hexal
    4. Carboplatino
    5. Carboplatinum
    6. Carbosin
    7. Carbosol
    8. Carbotec
    9. CBDCA
    10. Displata
    11. Ercar
    12. JM-8
    type
    DRUG
  5. arm Group Labels
    1. Group A (clinical observation)
    2. Group B (clinical observation, first-line chemotherapy)
    3. Group C (clinical observation, first-line chemotherapy)
    description
    Undergo clinical observation
    name
    Clinical Observation
    other Names
    1. observation
    type
    OTHER
  6. arm Group Labels
    1. Group A (clinical observation)
    2. Group B (clinical observation, first-line chemotherapy)
    3. Group C (clinical observation, first-line chemotherapy)
    description
    Undergo CT
    name
    Computed Tomography
    other Names
    1. CAT
    2. CAT Scan
    3. Computed Axial Tomography
    4. Computerized Axial Tomography
    5. Computerized axial tomography (procedure)
    6. Computerized Tomography
    7. Computerized Tomography (CT) scan
    8. CT
    9. CT Scan
    10. tomography
    type
    PROCEDURE
  7. arm Group Labels
    1. Group B (clinical observation, first-line chemotherapy)
    2. Group C (clinical observation, first-line chemotherapy)
    description
    Given IV
    name
    Cyclophosphamide
    other Names
    1. (-)-Cyclophosphamide
    2. 2H-1,3,2-Oxazaphosphorine, 2-[bis(2-chloroethyl)amino]tetrahydro-, 2-oxide, monohydrate
    3. Asta B 518
    4. B 518
    5. B-518
    6. B518
    7. Carloxan
    8. Ciclofosfamida
    9. Ciclofosfamide
    10. Cicloxal
    11. Clafen
    12. Claphene
    type
    DRUG
  8. arm Group Labels
    1. Group B (clinical observation, first-line chemotherapy)
    2. Group C (clinical observation, first-line chemotherapy)
    description
    Given IV
    name
    Doxorubicin Hydrochloride
    other Names
    1. 5,12-Naphthacenedione, 10-[(3-amino-2,3,6-trideoxy-alpha-L-lyxo-hexopyranosyl)oxy]-7,8, 9,10-tetrahydro-6,8,11-trihydroxy-8-(hydroxyacetyl)-1-methoxy-, hydrochloride, (8S-cis)- (9CI)
    2. ADM
    3. Adriacin
    4. Adriamycin
    5. Adriamycin Hydrochloride
    6. Adriamycin PFS
    7. Adriamycin RDF
    8. ADRIAMYCIN, HYDROCHLORIDE
    9. Adriamycine
    10. Adriblastina
    11. Adriblastine
    12. Adrimedac
    type
    DRUG
  9. arm Group Labels
    1. Group B (clinical observation, first-line chemotherapy)
    2. Group C (clinical observation, first-line chemotherapy)
    description
    Given IV
    name
    Etoposide
    other Names
    1. Demethyl Epipodophyllotoxin Ethylidine Glucoside
    2. EPEG
    3. Lastet
    4. Toposar
    5. Vepesid
    6. VP 16
    7. VP 16-213
    8. VP 16213
    9. VP-16
    10. VP-16-213
    11. VP-16213
    12. VP16
    type
    DRUG
  10. arm Group Labels
    1. Group A (clinical observation)
    2. Group B (clinical observation, first-line chemotherapy)
    3. Group C (clinical observation, first-line chemotherapy)
    description
    Undergo MRI
    name
    Magnetic Resonance Imaging
    other Names
    1. Magnetic Resonance
    2. Magnetic Resonance Imaging (MRI)
    3. Magnetic resonance imaging (procedure)
    4. Magnetic Resonance Imaging Scan
    5. Medical Imaging, Magnetic Resonance / Nuclear Magnetic Resonance
    6. MR
    7. MR Imaging
    8. MRI
    9. MRI Scan
    10. MRIs
    11. NMR Imaging
    12. NMRI
    type
    PROCEDURE
  11. arm Group Labels
    1. Group A (clinical observation)
    2. Group B (clinical observation, first-line chemotherapy)
    3. Group C (clinical observation, first-line chemotherapy)
    description
    Undergo ultrasound
    name
    Ultrasound
    type
    PROCEDURE
Study design
allocation
NON_RANDOMIZED
intervention Model
PARALLEL
masking Info
masking
NONE
primary Purpose
TREATMENT
Enrollment
count
621
type
ESTIMATED
Registered outcome plans (not posted results)
other Outcomes
  1. description
    Will be assessed by a descriptive analysis for the cohort of patients with localized tumors who progress after an initial period of observation.
    measure
    Time to intervention or tumor progression
    time Frame
    Up to 3 years
  2. description
    Will be assessed by a descriptive analysis for the cohort of patients with localized tumors who progress after an initial period of observation.
    measure
    Type of intervention required
    time Frame
    Up to 3 years
  3. description
    Will be assessed by a descriptive analysis for the cohort of patients with localized tumors who progress after an initial period of observation.
    measure
    Site of progression
    time Frame
    Up to 3 years
  4. description
    The coefficient of variation will be calculated to quantify the degree of inter-patient and intra-patient variability of etoposide and carboplatin PK. The relationship between patient characteristics will be assessed graphically in an exploratory fashion and with regression models and if appropriate, Spearman's rank correlation coefficient will be used. Correlations between PK parameters and the symptom score and hepatic and renal dysfunction will be explored. Logistic regression models adjusting for patient level covariates will be explored.
    measure
    Pharmacokinetic (PK) profile of carboplatin and etoposide in patients with stage Ms disease, including peak concentration, area under the curve, clearance, volume of distribution, half-life, and mean residence time
    time Frame
    Pre-dose, 1, 2, 4, 8, and 24 hours on days 1 and 2 of either course 1 or 7
  5. description
    Will be assessed by determining the presence or absence of each segmental aberration (segmental loss at 1p, 3p, 4p, or 11q or segmental gain at 1p, 2p, or 17q), both at initial biopsy and at the time of subsequent biopsy or surgical resection, and correlating with patient characteristics using a chi-squared test and with outcome using a log-rank test. In cases with specimens from diagnosis and at the time of subsequent biopsy/resection, the profiles will be compared focusing on changes in the copy number pattern.
    measure
    Genomic profile of tumors
    time Frame
    Up to time of biopsy or surgical resection
  6. description
    Will be assessed by a descriptive analysis of the histology of tumor specimens obtained at the time of subsequent biopsy or surgical resection.
    measure
    Histology of tumor specimens
    time Frame
    Up to time of biopsy or surgical resection
  7. description
    Will be assessed by calculating the overall survival for the cohort of patients with tumor relapse or disease progression.
    measure
    Salvage rate (overall survival [OS]) of patients with tumor relapse or disease progression
    time Frame
    From the date of enrollment until death or until last contact if the patient is alive, assessed up to 3 years
  8. description
    Will be assessed by determining the complication rate for each type of procedure (initial biopsy and resection \[intraoperative and postoperative\]) and correlating the occurrence of surgical complications with the degree of surgical resection using a Wilcoxon rank-sum test (to account for the ordering of the surgical resection categories).
    measure
    Procedural complication rate
    time Frame
    Up to 60 days after surgery
  9. description
    Will be assessed by computing the proportion of patients with L2 tumors for which each particular IDRF and any IDRF is present at diagnosis and then absent after observation or chemotherapy. In addition, McNemar's test for paired observations will be applied to determine whether there is a difference in the proportion of each IDRF and any IDRF present before and after observation or chemotherapy.
    measure
    Rate of reduction in Image Defined Risk Factors (IDRF) in L2 tumors
    time Frame
    Up to 3 years
primary Outcomes
  1. description
    The Kaplan-Meier method will be used to estimate the 3-year overall survival for each stratum. OS is measured from time of enrollment to the date of death from any cause.
    measure
    Overall survival (OS) (Strata 1-4)
    time Frame
    From date of enrollment until death or last contact, assessed up to 3 years
Full study description
brief Summary
This phase III trial studies how well response and biology-based risk factor-guided therapy works in treating younger patients with non-high risk neuroblastoma. Sometimes a tumor may not need treatment until it progresses. In this case, observation may be sufficient. Measuring biomarkers in tumor cells may help plan when effective treatment is necessary and what the best treatment is. Response and biology-based risk factor-guided therapy may be effective in treating patients with non-high risk neuroblastoma and may help to avoid some of the risks and side effects related to standard treatment.
detailed Description
PRIMARY OBJECTIVES: I. To eliminate therapy as the initial approach for infants \< 12 months of age with small International Neuroblastoma Risk Group (INRG) stage L1 neuroblastoma while maintaining an overall survival (OS) of 99%. II. To eliminate therapy as the initial approach for non-high-risk patients \< 18 months of age with localized neuroblastoma and favorable biology (histologic and genomic features) while maintaining an OS of 99%. III. To achieve a 3-year OS of \> 81% for infants \< 18 months of age with INRG stage Ms neuroblastoma using objective criteria for early initiation of a response-based treatment algorithm. EXPLORATORY OBJECTIVES: I. To describe the time to intervention or tumor progression, type of intervention and site of progression for patients with localized neuroblastoma who experience progression after an initial period of observation. II. To characterize the pharmacokinetic profile of the chemotherapeutic agents carboplatin and etoposide in patients with stage Ms disease. III. To define the genomic profile of tumors from patients with non-high-risk neuroblastoma both at initial biopsy and at the time of subsequent biopsy or surgical resection. IV. To describe the histology of tumor specimens obtained at the time of subsequent biopsy or surgical resection. V. To determine the salvage rate (OS) of patients with tumor relapse or disease progression. VI. To determine the procedural complication rate (initial biopsy, resection \[intraoperative and postoperative\], subsequent biopsy) and correlate with the degree of surgical resection. VII. To determine the rate of reduction in image defined risk factors (IDRF) in L2 tumors following observation or chemotherapy. OUTLINE: Patients are assigned to 1 of 3 treatment groups. GROUP A: Patients undergo clinical observation for 96 weeks in the absence disease progression. Patients also undergo computed tomography (CT), magnetic resonance imaging (MRI), and/or ultrasound throughout the trial. GROUP B: Patients undergo clinical observation for 3 years in the absence of disease progression. Upon disease progression, patients undergo surgery or receive first-line chemotherapy comprising carboplatin intravenously (IV) over 1 hour on day 1 (courses 1, 2, 4, 6, and 7), etoposide IV over 1 hour on days 1-3 (courses 1, 3, 4, 5, and 7), cyclophosphamide IV over 1 hour on day 1 (courses 2, 3, 5, 6, and 8), and doxorubicin hydrochloride IV over 15 minutes on day 1 (courses 2, 4, 6 and 8). Treatment with chemotherapy repeats every 21 days for 2-8 courses in the absence of disease progression or unacceptable toxicity. Once a partial response (PR) or better is achieved, patients undergo clinical observation for 3 years. Patients also undergo CT, MRI, and/or ultrasound throughout the trial and undergo bone marrow aspiration, bone marrow biopsy, and tumor biopsy at screening and time of progression. GROUP C: Patients at high risk for deterioration and a poor outcome immediately receive first-line chemotherapy as in Group B. All other patients undergo clinical observation for 3 years in the absence of disease progression. Upon disease progression, patients receive first-line chemotherapy as in Group B. Once a PR or better is achieved, patients undergo clinical observation for 3 years. Patients also undergo CT, MRI, and/or ultrasound throughout the trial and undergo bone marrow aspiration, bone marrow biopsy, and tumor biopsy at screening and time of progression. After completion of study treatment, patients are followed up annually for up to 10 years post-enrollment.
Source references
Source notices and limitations
    Discovery and provenance
    1. release id
      ctgov-registry-7ad944f6deaf1f5cd6122126
      edge id
      nct-edge-30ba96214999d515383f
      requested nct id
      NCT02176967
      primary nct id
      NCT02176967
      source kind
      nci_explicit_reference_or_link
      source record id
      Source null
      source file sha256
      308a08f515ba694b00db3851eb2531e1ed582dada1d1a75d9bb7c00853441821
      payload sha256
      89deb173c967e5f69d23d7d4e431eb09768748565cb2951600384b8d5359058c
      payload
      clinical indication matching status
      not_inferred
      end exclusive
      true
      id
      nct-edge-30ba96214999d515383f
      link basis
      explicit_NCT_identifier_in_acquired_source
      nct id
      NCT02176967
      occurrences
      1. context exact
        ith input from the surgeon to determine therapy for subsets of patients not at high risk, including those with L1, L2, and MS disease (<a href="/clinicaltrials/NCT02176967">ANBL1232 [NCT02176967]</a>, closed to accrual). Note that the INSS allows patients up to age 12 months to be classified as stage 4S, while the INRGSS allows
        end
        172901
        exact text
        NCT02176967
        start
        172890
      2. context exact
        eon to determine therapy for subsets of patients not at high risk, including those with L1, L2, and MS disease (<a href="/clinicaltrials/NCT02176967">ANBL1232 [NCT02176967]</a>, closed to accrual). Note that the INSS allows patients up to age 12 months to be classified as stage 4S, while the INRGSS allows patients up to age 18 m
        end
        172924
        exact text
        NCT02176967
        start
        172913
      3. context exact
        dex="-1">Some patients with presumed neuroblastoma have been observed without biopsy. The COG is studying this strategy further in the <a href="/clinicaltrials/NCT02176967">ANBL1232 (NCT02176967)</a> trial (closed to accrual).[<a href="#cit/section_7.4">4</a>,<a href="#cit/section_7.5">5</a>]</p> <p id="_620" tabindex="-1
        end
        340440
        exact text
        NCT02176967
        start
        340429
      4. context exact
        with presumed neuroblastoma have been observed without biopsy. The COG is studying this strategy further in the <a href="/clinicaltrials/NCT02176967">ANBL1232 (NCT02176967)</a> trial (closed to accrual).[<a href="#cit/section_7.4">4</a>,<a href="#cit/section_7.5">5</a>]</p> <p id="_620" tabindex="-1">Treatment options fo
        end
        340463
        exact text
        NCT02176967
        start
        340452
      5. context exact
        or intervention. Additional studies, including an expansion of criteria allowing observation without surgery, are under way in the COG <a href="/clinicaltrials/NCT02176967">ANBL1232 (NCT02176967)</a> study (closed to accrual).</p> <p id="_823" tabindex="-1">Evidence (observation without biopsy):</p> <div class
        end
        343828
        exact text
        NCT02176967
        start
        343817
      6. context exact
        onal studies, including an expansion of criteria allowing observation without surgery, are under way in the COG <a href="/clinicaltrials/NCT02176967">ANBL1232 (NCT02176967)</a> study (closed to accrual).</p> <p id="_823" tabindex="-1">Evidence (observation without biopsy):</p> <div class="pdq-content-list"><ol
        end
        343851
        exact text
        NCT02176967
        start
        343840
      7. context exact
        ny patients did not progress locally and never underwent a first or additional resection.[<a href="#cit/section_7.5">5</a>] In the COG <a href="/clinicaltrials/NCT02176967">ANBL1232 (NCT02176967)</a> study (closed to accrual), infants younger than 18 months who have L2 tumors with favorable biology are being observed after tumor
        end
        345348
        exact text
        NCT02176967
        start
        345337
      8. context exact
        gress locally and never underwent a first or additional resection.[<a href="#cit/section_7.5">5</a>] In the COG <a href="/clinicaltrials/NCT02176967">ANBL1232 (NCT02176967)</a> study (closed to accrual), infants younger than 18 months who have L2 tumors with favorable biology are being observed after tumor biopsy. </p> </
        end
        345371
        exact text
        NCT02176967
        start
        345360
      offset unit
      unicode_code_points
      source file
      /tmp/cancer-full-research/nci/raw/d023d406c02e860e22.html
      source file sha256
      308a08f515ba694b00db3851eb2531e1ed582dada1d1a75d9bb7c00853441821
      source json pointer
      Source null
      source kind
      nci_explicit_reference_or_link
      source record id
      Source null
      source retrieved at
      2026-09-09T23:22:09.227808+00:00
      source string basis
      UTF-8_text_with_universal_newline_translation
      source string sha256
      5a0bcb41a33182c1bb316ea92b74ca10701add33aec3077a54a565e6d80cbf53
      source title
      Neuroblastoma Treatment (PDQ®)–Health Professional Version
      source update dates
      1. context
        Updated: April 28, 2025
        datetime
        2025-04-28T12:00:00Z
        display
        April 28, 2025

    Preserved source evidence · Not medical advice