What treatment would you give to a pediatric patient with first relapse of wilms tumor?

First consideration should be to review and treat as per NWTS-5 relapse arm. Prior chemo will dictate which chemo should be selected at relapse (*i.e. if prior Dox then Cyclo/Etop alt w/Carbo/Etop vs. no Dox = regimen I). Don't forget to address local and metastatic disease w/Surgery+/-RT using prot...

While I agree that the NWTS5 regimens should be considered, and has the highest quality evidence (prospective, phase III clinical trial), that was a different treatment era and we have to consider what we've learned since then about other active agents for Wilms Tumor.

For example, we know that Topot...

@Dr. First Last - Your point that alternative regimens have improved activity in the relapse setting is well taken, and addition of these agents/combinations to NWTS-5 like relapse/treatment paradigms is warranted.

For this reason, AREN1921 (NCT04322318) will be integrating VI with Cyclo/Carbo/Etop...