Multiple approaches are currently under investigation in phase-I, phase-II, and phase-III studies based on antibody targeting of the GD2 ganglioside expressed in >95% of neuroblastoma (see Chap. 14). Treatment with either murine or chimeric anti-GD2 antibody, with or without cytokines, or conjugated to iodine-131, has shown promise for minimal residual and bone marrow disease in refractory and newly diagnosed patients, with responses in phase-I and phase-II studies of 10-20% (Frost et al. 1997; Uttenreuther-Fischer et al. 1995; Handgretinger et al. 1995; Hank et al. 1994; Cheung et al. 1987,1989; Saleh et al. 1992; Yu et al. 1997; Ozkaynak et al. 1998).A phase-III randomized trial is currently underway in the COG for treatment of minimal residual disease following myeloablative therapy. Current trials in refractory disease are testing the humanized anti-GD2, Hu14.18, covalently linked to interleukin-2 (IL-2; immunocy-tokine), or use with an immunologic enhancer such as glucan (Cheung and Modak 2002). An antiidiotype vaccine to anti-GD2, using the monoclonal antibody 1A7 with adjuvant, has completed phase-I testing in neuroblastoma, with evidence of immunologic response.

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