Relapse of acute lymphoblastic leukemia (ALL) remains a leading cause of mortality in childhood cancer. IntReALL 2020 will conduct randomized and historically controlled trials in children with relapsed B-cell precursor (BCP) ALL with the aim to replace toxic chemotherapy with better tolerated and more efficacious immunotherapeutic drugs. In standard risk (SR) patients, the CD22 directed antibody-drug conjugate inotuzumab ozogamicin (InO) will be randomly compared with standard of care (SOC) ALL-R3 induction. All patients will receive one SOC consolidation- and one Blina course, compared to historical controls. SR patients with MRD good response will receive 2 additional Blina courses replacing chemotherapy randomly compared with SOC. Patients with high-risk relapse will receive induction investigating InO versus ALL-R3 in an industry-sponsored trial, followed by IntReALL consolidation and allogeneic HSCT. Patients with isolated extramedullary (IEM) relapse are treated based on ALL-REZ BFM 2002 backbone. IntReALL 2020 will establish a federated relapsed/refractory leukaemia board generating personalized recommendations based on clinical, molecular-genetic and drug response profiling data. Patients with very-high risk disease will receive experimental/personalized therapies, including a trial investigating CD19-directed chimeric receptor antigen (CAR) T-cells produced in academic institutions. Other CAR T-cells trials as well as an induction trial for T-ALL relapse will be developed. Documentation and monitoring of the trials and the individualized treatment will be realized using the MARVIN database. Comprehensive statistical and data management activities will warrant the accuracy and interpretability of the data. IntReALL 2020 involves representatives from participating pharmaceutical companies and EMA as well as patient/parent advocates to discuss strategies for developing new drugs within academic trials warranting a benefit for all patients on the results. “This action is part of the Cancer Mission cluster of projects on ‘Diagnosis and treatment’.”

High-risk neuroblastoma accounts for 15% of cancer related-deaths in children. Half of the >1500 patients yearly diagnosed with neuroblastoma in the EU have high-risk disease, which will relapse or progress in half these cases after first-line treatment. Relapsed neuroblastoma is aggressive and often therapy-resistant. Monitoring for disease relapse and therapy response is crucial for the survival chance of these patients. The current standard-of-care for monitoring are imaging technologies and bone marrow assessment, which are costly, invasive and a burden for children, who often require anesthesia. These drawbacks limit how often is monitored. More sensitive, less invasive and less toxic monitoring techniques are needed. The mutational spectrum often changes in recurring tumors, which may explain therapy resistance and provide additional druggable targets. Imaging, however, provides no information about molecular characteristics. Liquid biopsy tests are minimally invasive, allow frequent sampling and sensitively detect tumor molecular markers in tumor-derived DNA and messenger RNA circulating in peripheral blood. MONALISA aims to close existing gaps and establish liquid biopsies as standard-of-care to monitor relapsed/refractory neuroblastoma, as a blueprint for other pediatric cancers. Reliable, early assessment of molecular progression or relapse is the main aim of the pragmatic randomized clinical trial proposed in MONALISA. We develop a digital decision support tool to help oncologists use the new monitoring and apply patient-reported outcomes to integrate patient viewpoints and assess the effect of minimally invasive, liquid biopsy diagnostics on quality of life. We will establish whether events can be detected earlier using liquid biopsy monitoring, and whether better overall survival is enabled by earlier diagnosis and treatment interventions. This essential step towards personalized medicine will support reliable disease monitoring under treatment. “This action is part of the Cancer Mission cluster of projects on ‘‘Diagnostics and Treatment (diagnostics).”