What happens if my child doesn’t respond to frontline treatment? 

If a child’s neuroblastoma does not respond as expected to initial (frontline) treatment, this is sometimes described as refractory neuroblastoma. This means that the cancer has not shrunk enough, has stopped responding to treatment, or has continued to grow despite treatment. 

If this happens, your child’s medical team will review what has happened so far and discuss next steps with you. There are often still treatment options available, and plans are tailored to each child’s individual situation. 

What happens next? 

If frontline treatment has not been effective, your child’s specialist team will usually: 

• review how the cancer has responded so far 

• consider whether the disease has stayed in the same place or spread 

• look again at the tumour’s biological and genetic features 

• discuss different treatment approaches that may be more suitable 

Decisions are made by an experienced multidisciplinary team, often with input from national or international neuroblastoma specialists. 

Further treatment options 

Treatment after frontline therapy may involve one or more of the following, depending on your child’s circumstances: 

• Different chemotherapy combinations: 
  Your child may be offered different chemotherapy drugs from those used during frontline treatment, to try to better control the cancer. 

• Targeted therapies: 
  Some treatments target specific genetic features of the tumour, such as ALK mutations, and may be suitable for some children. 

• Immunotherapy: 
  Immunotherapy treatments aim to help the immune system recognise and attack neuroblastoma cells. These may be used in different ways from frontline treatment. 

• Radiotherapy or molecular radiotherapy: 
  Radiotherapy may be used to treat specific areas of disease. Some children may be offered molecular radiotherapy, such as mIBG therapy, which delivers radiation directly to neuroblastoma cells. 

• Clinical trials: 
  Children whose cancer does not respond to frontline treatment are often considered for clinical trials. Trials may offer access to newer treatments or new combinations of treatments. Taking part in a trial is always a choice, and your child will continue to receive the best available care whether or not you join a trial. 

Read more about clinical trials.

Your child’s medical team will explain which options may be appropriate, what they are hoping to achieve, and the possible benefits and risks. 

Why treatment plans can change 

Neuroblastoma can behave very differently from one child to another. When frontline treatment is not effective: 

• treatment plans often become more individualised 

• options may change depending on how the cancer responds 

• doctors may try different approaches over time 

• your child’s treatment plan may look different from those of other children 

Your child’s team should take time to talk through these changes with you and answer any questions you have. 

Support for your family 

Hearing that treatment has not worked as hoped can be extremely difficult. Alongside your child’s medical care, emotional and practical support for your family is important. You can speak to your child’s treatment team at any time, and support is also available through our Family Support Team.