Innovations and Challenges in Pediatric Oncology: A Focus on Sub-Saharan Africa

On March 26, 2024, the Foundations in Global Health (FIGH) Series featured a lecture titled "Bridging Gaps in Global Pediatric Oncology: Innovations in Genetics and Laboratory Testing" by Julie M. Gastier-Foster, PhD, FACMG. Dr. Gastier-Foster, a Professor in the Department of Pediatrics, Section of Hematology and Oncology at Baylor College of Medicine, and the Director of Laboratory and Pathology at the Global Hematology/Oncology Pediatric Excellence (HOPE) Program, Texas Children’s Hospital, provided profound insights into the critical challenges and innovative solutions in the field of pediatric oncology, particularly in sub-Saharan Africa.

The lecture began with an alarming comparison: while in the United States, 80% of the 15,000 children who develop pediatric cancer annually survive, in sub-Saharan Africa, 90% of over 100,000 afflicted children do not survive. This stark disparity underscores the urgency of Dr. Gastier-Foster's work.

The Global HOPE Program, launched in 2016 with a foundational investment from the Bristol Myers Squibb Foundation, aims to radically improve treatment outcomes for children with cancer and blood diseases in sub-Saharan Africa. The program collaborates closely with local Ministries of Health and universities to strengthen healthcare infrastructure and build local capacity, including pediatric hematology-oncology (PHO) Fellowship programs in Uganda, Tanzania, and partnerships in South Africa.

Dr. Gastier-Foster highlighted the essential role of pathology and laboratory medicine services in accurately diagnosing and treating pediatric cancer. She underscored the severe limitations faced in low-resourced settings, such as delays in diagnosis, lack of trained healthcare professionals, inadequate healthcare infrastructure, and poor access to necessary drugs and treatments. Additionally, socio-cultural barriers and diseases like HIV/AIDS complicate the pediatric cancer burden.

In response to these challenges, Global HOPE has implemented critical strategies, including the training of African pathologists, the introduction of flow cytometry for leukemia diagnosis in Malawi, partnerships for equipment and reagent supply, and the implementation of molecular testing for pediatric cancer. One notable advancement is the use of NanoString nCounter^® Technology for fusion analysis, offering a rapid, cost-effective, and robust method for detecting gene fusions, which are crucial for diagnosis, prognosis, and targeted therapy.

The lecture also presented local proof of principle cases from Uganda, demonstrating the efficacy of these innovations in improving diagnostic accuracy and treatment decisions. Despite these advancements, Dr. Gastier-Foster emphasized the ongoing challenges, such as the high cost of molecular reagents and the need for sustainable supply chains.

The lecture underscored the critical need for continued innovation and collaboration in bridging the gaps in global pediatric oncology, showcasing the transformative impact of Dr. Gastier-Foster's work and the Global HOPE Program in the fight against pediatric cancer in low-resource settings.