MONALISA project: developing less invasive monitoring systems for neuroblastoma through EU Cancer Mission funding

At the occasion of Childhood Cancer Awareness Month, observed annually in September, HaDEA has reached out to the Horizon Europe project MONALISA (A SIOPEN pragmatic clinical trial to MOnitor NeuroblastomA relapse with LIquid biopsy Sensitive Analysis), funded under the EU Cancer Mission. MONALISA is studying the benefit of liquid biopsies in monitoring neuroblastoma, a paediatric cancer. Its main goal is to test in a clinical trial if liquid biopsies can detect relapse earlier and in a less invasive manner than the current standard of care diagnostics and consequently avoid unnecessary diagnostic procedures and stress for patients. 

Three project representatives have answered a few questions to present MONALISA: Samira Essiaf, CEO of the European Society for Paediatric Oncology (SIOP Europe), Coordinator of MONALISA; Lieve Tytgat, clinical investigator and co-scientific leader, from Princes Maxima Centrum; and Sabine Taschner-Mandl, molecular biologist and co-scientific leader from St. Anna Children’s Cancer Research Institute.  

Could you shortly present MONALISA and its relevance in the field of childhood cancer? 

MONALISA is an international project focused on improving care for children who have been treated for a type of cancer called neuroblastoma. After treatment, more than half of the children with high-risk neuroblastoma may experience a return of the disease. MONALISA aims to detect these relapses earlier than current methods, which could help doctors act sooner and improve the chances of survival. 

What makes MONALISA special is that it is the first clinical trial of its kind to test whether a new type of blood test, called a liquid biopsy, can be used to monitor childhood cancer more effectively. The goal is to make this approach part of everyday care for neuroblastoma and eventually use it as a model for other childhood cancers too. 

The project also uses digital tools to help doctors make better decisions, and assesses emotional stress of patients and families. By doing this, MONALISA hopes to improve the quality of life for young patients. 

To test this approach, MONALISA will run a clinical study in 11 countries, comparing the new method with the current standard. If successful, it could lead to earlier diagnosis and better outcomes for children around the world. 

Could you elaborate on the advantages of liquid biopsies compared to traditional monitoring systems (medical imaging and bone marrow examinations), especially for children?  

Currently, doctors usually monitor children with neuroblastoma using scans and bone marrow tests. These methods can be expensive, uncomfortable, and stressful - not just for the child, but also for their families. They often require hospital visits, sedation, or even anaesthesia, which can be tough on young patients and cause side effects. 

Liquid biopsies offer a gentler, less invasive, alternative. These are simple blood tests that can pick up tiny traces of cancer-related genetic material in the blood. They are much less invasive, do not require anaesthesia, and can be done more often, making it easier to catch signs of the cancer returning early. 

Our research team has already found that these blood tests can often detect a relapse before symptoms appear or before it shows up on a scan. If we can bring this into everyday medical care, it could really change how we look after children with cancer, making the process less painful and more effective. 

Have you encountered any significant challenges in implementing your project and integrating your solutions in broader healthcare systems?  

We have had a few important challenges along the way. One of the first was making sure that all laboratories involved in the project across different countries use the same procedures for the liquid biopsy tests. This is really crucial because we want these tests to be available to as many children as possible, no matter where they live. We have now reached that goal and have also finished designing the clinical trial, so we are ready to start enrolling patients. 

Another challenge is making sure that all the patient data we collect, from both new and existing sources, can be safely and smoothly connected. This helps us analyse the results more effectively, while still protecting patients’ privacy. 

Looking ahead, we are also working on how to bring these new tools into everyday healthcare systems, including figuring out how they could be covered by health insurance. That is something we are going to explore in the next phase of the project. 

How important is the support of EU funding for your project? 

The support we receive from the EU Cancer Mission (through HaDEA) is absolutely essential for making the MONALISA project possible. It helps us bring together all the hospitals and experts we need, most of them from the SIOPEN research network, so we can include more children in the study across different countries. 

The funding also allows us to add important tools to the project, like a digital support system for doctors and a mobile app for families to help track emotional well-being. It also helps us work with small companies and research teams who bring fresh, innovative ideas to the table. 

Beyond that, we’re counting on the EU Cancer Mission to help spread the word about our results and support the use of less invasive cancer monitoring tools - like liquid biopsies - across Europe’s healthcare systems. 

Relevant links

MONALISA: watch the project's video

Background 

Horizon Europe is the research and innovation programme of the EU for the period 2021-2027. The aims of Cluster 1 ‘Health’  include improving and protecting the health and well-being of citizens of all ages by generating new knowledge, developing innovative solutions and integrating where relevant a gender perspective to prevent, diagnose, monitor, treat and cure diseases. Horizon 2020 (H2020) was the EU’s multiannual funding programme between 2014 and 2020. 

The EU Cancer Mission, alongside Europe's Beating Cancer Plan, represents the European Commission's strategy. By investing in research and collaborating with citizens and a broad range of stakeholders, the Mission generates new evidence and fosters innovative concepts to inform policy actions across its 4 key objectives: understanding cancer, prevention and early detection, diagnosis and treatment, and improving quality of life.