Advancing paediatric cancer research through partnerships 

Handshake jigsaw puzzle

Paediatric oncologist Gauri Sunkersett shares her unique background and research approach at AbbVie to help find answers for the youngest blood cancer patients.  

When I was a second-year resident training as a paediatric oncologist at Nicklaus Children’s Hospital, I met a teenage boy diagnosed with Hodgkin’s Lymphoma. He was admitted to the hospital for weekly chemotherapy. When I made afternoon patient rounds, I would find him sitting up in his hospital bed doing homework. Not playing video games, not sleeping. He was so focused on the path ahead. Despite all the hurdles he was facing, he had a list of goals that he wanted to achieve. I was impressed by his determination and proud to be part of his team. 

But I also recall other moments that made me painfully aware that significant efforts are needed in the treatment of children with cancer. When I was in clinical practice, some of the patients were under my care for my entire tenure at Johns Hopkins All Children’s Hospital. Unfortunately for many, our time together was faced with one relapse after another. It becomes challenging as a provider to know that by relapse number eight – after many unsuccessful clinical trials and rounds of toxic chemotherapy – we may have nothing left to offer our patients despite the hope their families keep.  

One of the hardest things I had to do was to tell my patients’ families I was leaving Johns Hopkins and pivoting my career towards drug development within the pharmaceutical industry. As a physician, you have the privilege of building trust with your patients and their families. However, one parent said to me: 

“As much as we are going to miss you, we are so excited about your new career choice because we need people like you that care about kids and understand the challenges they face.” These words and this patient remain on the forefront of my mind every day in my work.  

When I arrived at AbbVie, my responsibility was to oversee late-stage development of oncology therapeutics for paediatric cancers. With these responsibilities came an unwavering commitment to lead my team in making a difference in the lives of the many children and their families across the globe who were desperate for change in how their cancer could be managed.  

Paediatric cancer patients are different 

Finding new treatment options for children with cancer can be difficult, particularly those with relapsed or refractory leukaemia where the same types of treatments have been used for decades. There is no ‘one-size-fits-all’ approach for these patients.  

The differences in treating children versus adults diagnosed with cancer are striking including how we look at disease biology, dosing regimens and medication administration. By understanding the unique characteristics of paediatric cancer patients and adapting existing strategies to better meet their needs, I believe that we can usher in a new era of cancer care that fundamentally changes how children are treated. We owe nothing less to them. 

To date, much of the conversation in oncology research and development has focused on treatments for adults. In most cases, clinical trial data for paediatric patients is limited and even therapies identified in early development have even been terminated without paediatric testing – simply because they were found to be unsuccessful in older patients. That could be a missed opportunity. But over the course of my career, I have seen the tides begin to turn as practicing clinicians, researchers, advocacy groups and pharmaceutical companies advance conversations around the needs of our shared north star – the patient.  

In many ways, it is fortunate that paediatric cancer is considered a rarity by the medical community. However, when it comes to drug development, scarcity in paediatric cancer diagnoses – especially when compared to adults – often comes with its own set of challenges. Historically, smaller patient numbers have led to fewer studies and resources, which has severely limited the number of treatments available on the market. As an unfortunate result, only 5% of cancer drugs have been approved for first-time use in children, creating significant unmet needs in paediatric care that demand our collective attention. 

When considering the differences between paediatric and adult cancer patients, it is important to start by recognising that children with cancer are still physically developing while receiving treatment – which could create growth and developmental issues. What’s more, although paediatric patients are more likely to be impacted by long-term side effects, for instance, secondary to radiation treatments, they are generally able to tolerate more aggressive therapies compared to some adult patients with multiple comorbidities. With this in mind, therapies that may initially be considered ineffective due to their aggressive nature for adult patients may have the potential to be safe and effective for paediatric patients. By widening our perspectives regarding optimal patient outcomes with an eye for these characteristics and more, I believe that we can more effectively meet the needs of all patients, even the youngest ones.   

Daring to dream bigger, together 

If we hope to address the large unmet need facing paediatric patients today, we must be willing to break down silos impeding knowledge sharing, spurring new and different therapeutic approaches right from the beginning of the research and development process. In this context, partnerships between industry and non-profit health organisations can be a powerful concept. One great example is the Dare to Dream Project led by The Leukemia & Lymphoma Society (LLS). At the heart of this initiative is the Pediatric Acute Leukemia (PedAL) Master Clinical Trial, a first-ever collaborative clinical study to test multiple therapies among children with relapsed acute leukaemia at clinical sites around the world. 

This trial will break down silos for future research and care and continue the rich history of the LLS in bringing together the best minds across the cancer ecosystem. It has been rewarding to collaborate with the LLS and the Dutch Princess Máxima Center for Pediatric Oncology for one of AbbVie’s pivotal clinical studies evaluating one of our treatments in relapsed paediatric leukaemia. The LLS in particular is extremely well connected to the paediatric oncology community through their advocacy and mission. As a corollary to that, the Princess Máxima Center is tightly connected to the global scientific and medical community. Having the insight and partnership with these two large organisations not only helps us cement our commitment but also achieve our goal to have impactful, large-scale paediatric trials. 

I have seen what can happen when you bring together innovative cancer researchers, advocacy groups and other supporters to improve the patient journey. I am a firm believer that collaboration holds the key to unlocking urgently needed optionality within paediatric oncology and that together, we can accelerate the development of safer and more effective treatments for children.  

Final thoughts 

As a paediatric oncologist, you bear witness to all kinds of patient journeys – some are successful, and some are heartbreaking. You are there for the ups and the downs, helping your patients navigate an uncertain road ahead of them with the currently limited therapeutic options at your disposal. For far too long, the needs of paediatric cancer patients have been overshadowed by extrapolations from their older counterparts. It is time that we join forces to break this cycle – educating the broader oncology and research community about the unique needs of paediatric cancer patients in order create new therapies that help them get back to being a child, not just a patient.  

About the author 

Gauri Sunkersett, D.O., is a board-certified Paediatric Haematologist/Oncologist with subspecialty training in haematopoietic stem cell transplantation and is a medical director at AbbVie leading development across multiple assets for paediatric indications.  

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