As 12-year-old Giovanna leaned forward on the school desk, she was trying to concentrate on the lesson and what the teacher was saying. But as she put her hand on her neck, she felt a lump.
Her parents Josiane and Sgessiel took her to the hospital, and over the subsequent weeks Giovanna who is known affectionately as Gio, underwent several scans and blood tests. A cloudy mass was discovered near her right lung and after a biopsy, it was confirmed as neuroblastoma, a childhood cancer that is usually seen in younger children. The disease originates from developing nerve cells.
“Throughout all the tests, the doctors were open with us that it could be cancer,” Gio bravely explains. “We knew it was a possibility, but it was still a shock when they said those words and I was really scared.”
Sgessiel added: “It was awful. Gio was a healthy, active, child. She was always playing sports and eating the right things. You just don’t think it could happen to you. We were devastated.”
Gio underwent chemotherapy. She experienced sickness and lost her hair – something that she was very worried about. However, her friends rallied around her, and they even shaved their heads in solidarity.
“Chemo was really hard,” Gio added. “I was in hospital a lot and missed a lot of school. I couldn’t believe my friends when they arrived at my home with no hair! They have really helped me. The chemo reduced the tumour but not as much as the doctors wanted.”
Gio then took part in a trial of new medication which is known to have a good response to neuroblastoma. However, the side effects of the medication, which included hallucinations, became too much for Gio and she had to be put back onto a regular cycle of chemotherapy.
It was then, that her doctor suggested taking part in the MiNivAN trial at the University of Southampton.
Led by Professor Juliet Gray, at the Centre for Cancer Immunology, the MiNivAN study combines 131-I mIBG targeted radiation therapy with two different antibodies, Nivolumab and Dinutuximab beta. Dinituximab beta, an anti-GD2 antibody, has been widely used in neuroblastoma and targets the cancer cells, allowing them to be seen and killed by one’s own immune system.
In contrast, Nivolumab targets the immune system rather than the tumour itself, boosting the body’s immune response to the cancer. The study is led by the team in Southampton, in collaboration with colleagues in London, US and Germany and patients with neuroblastoma from across the UK have travelled to Southampton to take part in the study. It is it funded by a consortium of charities including Solving Kids Cancer UK, J.A.C.K and Band of Parents. It aims to test whether this combination of antibodies can be given together with the mIGB therapy, with the aim that the complementary effects will enhance the immune the effects and leave children with long-term immunity against their disease.
The study was launched in 2018 and has recently finished recruiting. Gio, who is now 14, is one of the last patients to receive the treatment and is expected to complete the trial in February.
She added: “The trial has been a positive experience so far. I’ve felt well enough to continue to dance and sing with my church group, who have been so supportive. That’s been very important in my overall wellbeing. When I’m dancing and singing, nothing else matters, so to be able to continue has been a gift.”
Professor Juliet Gray said: “Sadly, high risk neuroblastoma is one of the most challenging childhood cancers, with less than half of children surviving this aggressive disease despite really intensive treatment. New and less toxic treatments are desperately needed.
“Work in the laboratory has shown that combining radiation therapy with two different types of antibodies, one which targets the tumour and one which targets the immune system, is potentially a very powerful way of eradicating neuroblastoma tumours and they appear to work together to generate strong, protective immunity to the tumour. This is what we are testing in the MINivAN trial.
“We are really pleased to have finished recruiting for the trial, which has been a massive undertaking by everyone involved due to the number of centres involved. We are really encouraged by some of the results we’ve seen. We will now analyse all the data to establish whether we have the evidence to test this treatment further in larger trials. We’d like to thank all the patients and families who has taken part in the trial and helped us to try and find new and better ways to treat this really difficult cancer.”
