Refractory and relapsed neuroblastoma is very difficult to eradicate, due to multiple mechanisms of drug resistance. Above all, compassion and consideration for quality of life must be incorporated into the therapeutic goals for the child with refractory neuroblas-toma. Currently established therapies include only a few chemotherapeutic and targeted agents, and of these, only the chemotherapy agents are commercially available. Future success depends on rational pre-clinical in vitro and in vivo testing of new agents and combinations in panels of appropriate neuroblas-toma cell lines and tumors, followed by careful clinical trials. Judicious selection of trials depending on the type of relapse, and willing cooperation of patients and parents after careful explanation of the goals of the study are essential to improve survival in this disease.

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