Tumor Rebiopsy in Children and Adolescents With Recurrent or Progressive Solid Malignancies

It has been shown that the genomic landscape of tumors can dramatically change at the time of disease progression. This suggests that therapies aimed at treating the tumor at diagnosis may not be relevant at the time of relapse. Obtaining fresh tissue at the time of relapse could facilitate the identification of potential targets that have developed through mutational evolution of the primary tumor and would provide an unprecedented opportunity to expand the library of patient derived xenografts (PDX) that are available for comprehensive preclinical testing in the setting of relapsed disease. The purpose of this observational study is to prospectively collect fresh tumor tissue from pediatric patients with solid tumors who have recurrent or progressive disease and submit this tissue for comprehensive genomic analysis using clinically available CLIA-certified platforms that include WGS, WES and RNAseq, and to assess the reasons for a patient and/or a parent for making a decision to proceed with or refuse a re-biopsy procedure in the presence of a recurrent or progressive solid tumor. The data obtained will be used to develop new novel therapies that incorporate new pharmacological agents in pediatric solid tumors. PRIMARY OBJECTIVES: * To prospectively collect fresh tumor tissue from pediatric patients with solid tumors who have recurrent or progressive disease and submit this tissue for comprehensive genomic analysis. * To assess the reasons a patient and/or a parent make the decision to proceed with or refuse a re-biopsy procedure in the presence of a recurrent or progressive solid tumor. SECONDARY OBJECTIVES: * To estimate refusal and acceptance rates for re-biopsy and the parental/patient attitudes towards a re-biopsy. * To estimate the incidence of complications associated with biopsy. * To estimate the percentage of procedures that fail to obtain adequate tissue for genomic analysis.

Sex

All

Minimum age

2 Years

Maximum age

21 Years

Inclusion Criteria:

* Age 2-21 years
* Patient has been diagnosed with a solid tumor malignancy that is recurrent or progressive and for whom there is no fresh tumor specimen available.
* Availability of gross disease amenable to biopsy.
* Karnofsky ≥ 50% for patients \>16 years of age and Lansky ≥ 50 for patients ≤ 16 years of age.

Exclusion Criteria:

* Diagnosis of a non-solid tumor malignancy.
* Patient with known coagulopathy that requires replacement therapy.
* Patient with anesthesia risk that would place the patient at a higher than expected risk for complications (ASA PS4 and ASA PS5).
* Karnofsky or Lansky performance score of \< 50.
* BMI for age \> 95th percentile.
* Refusal or inability to provide written informed consent according to institutional guidelines.