To facilitate access to precision medicine for all children and adolescents with cancer, regardless of their area of residence. This is the objective of the SEHOP-PENCIL project, developed by the Spanish Society of Pediatric Hematology and Oncology (SEHOP) and coordinated by the Pediatric Hematology and Oncology Department of the Vall d'Hebron University Hospital and the Childhood Cancer and Blood Disorders group of the Vall d'Hebron Research Institute (VHIR), which has been financed with 2 million euros by the Instituto de Salud Carlos III, dependent on Ministry for Science and Innovation, with European funds from the Recovery, Transformation and Resilience Plan. It involves 12 hospitals and research centers together with medical-scientific and patient associations which, over a period of four years, will design and evaluate a nation-wide sequencing program for childhood tumors in order to implement personalized medicine among the standards for diagnosis and treatment and to improve survival.

The SEHOP-PENCIL study builds on previous work that analyzed data from 29 national centers on where and when molecular and tumor sequencing studies are conducted, the technology used, and the clinical applicability of the results in terms of access to targeted treatments. "Thanks to a survey, we found that there are important differences in access to personalized medicine studies between different centers", says Dr. Lucas Moreno, head of the Pediatric Hematology and Oncology Department at Vall d'Hebron University Hospital and of the Childhood Cancer and Blood Disorders group at VHIR. "With SEHOP-PENCIL we want to establish a state-wide coordination strategy to overcome these differences", adds Dr. Moreno.

The project will involve more than 500 patients with pediatric tumors treated in any hospital in the territory, and is especially aimed at high-risk cases, i.e. those with a higher mortality rate. Using different techniques, the tumors will be sequenced at the time of diagnosis or at relapse. "Knowing the molecular biology of the tumor will help to identify specific alterations that allow us to offer targeted therapies to improve survival", explains Dr. Aroa Soriano, principal investigator of the Childhood Cancer and Blood Diseases group at VHIR. These analyses will also help to improve diagnosis and stratify patients according to their risk, which will allow to reduce the intensity of treatment in those patients with better prognosis and, therefore, to reduce toxicity and long-term sequelae. Finally, they will study the existence of hereditary cancer predisposition syndromes, which exist in up to 10% of childhood cancers and whose detection allows us to start early detection programs in patients and their families.

Finally, work will also be done on the development of new technologies, such as liquid biopsy, i.e., the analysis of blood samples that may contain cancer cells or genetic material from the tumor. Its study offers the possibility of evaluating the heterogeneity of the tumor and monitoring the response to treatments in a simpler, less invasive and more efficient way than a regular tissue biopsy.

Coordination networks between centers to overcome differences

To facilitate access to sequencing techniques and precision medicine for all children with cancer, coordinated networks of experts will be established between national pediatric oncology centers, with 10 hubs or genomic centers that will have the capacity to sequence samples arriving from other hospitals. This will help to minimize travel for patients.

The ultimate goal of SEHOP-PENCIL will be for precision medicine to be incorporated into the service portfolio of any hospital, and its usefulness and effectiveness will be studied. This will allow Spain to join the leading European countries in pediatric oncology which have already incorporated these studies at the first line. Initially, the project will be carried out in patients with high-risk tumors, but once it is implemented it is hoped that it will be able to reach all pediatric cancer patients.

SEHOP-PENCIL is an eminently collaborative project of all hospitals and research centers in childhood cancer coordinated by VHIR and the Vall d'Hebron University Hospital, from where it will also work on advanced sequencing techniques and the search for new treatments for patients whose cancers have relapsed. Also participating are the Instituto de Investigación Hospital Universitario la Paz, Sociedad Española de Hematología y Oncología Pediátrica, Instituto de Investigación Sanitaria La Fe - Hospital Universitario y Politécnico La Fe, Instituto de Biomedicina de Sevilla - Hospital Universitario Virgen del Rocío, Instituto de Investigación de Enfermedades Raras-Instituto de Salud Carlos III, Fundación de Investigación CRIS CONTRA EL CÁNCER, Fundación de Investigación del Hospital Infantil Universitario Niño Jesús, Hospital Sant Joan de Déu Barcelona - Institut de Recerca Sant Joan de Déu, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria Biocruces Bizkaia and Servicio de Salud de Castilla la Mancha.

Childhood cancer

Every year more than 1800 new cases of cancer are diagnosed in children and adolescents in Spain according to the Spanish Society of Pediatric Hematology and Oncology (SEHOP). Pediatric cancers are considered rare diseases, which include more than 60 very heterogeneous types that differ from adult cancers.

Despite improvements in current therapies, survival has remained stable over the last decade and cancer is the leading cause of death in children over one year of age, in addition to causing sequelae in many survivors. Precision medicine is changing the paradigm of cancer treatment with the aim of stratifying patients according to their prognosis and offering more effective targeted therapies with less toxicity.