Innovations in treating pediatric cancers have been slow to develop, despite the fact that childhood cancers are biologically different from adult cancers. While these differences play a role, they are not the main reason for the lack of progress. The pharmaceutical industry's business model and current regulations also contribute to the challenge. Major breakthroughs in adult cancer treatment, such as early detection methods, new drugs, and improved surgery and radiation techniques, have not been quickly adapted for children and adolescents. There are over 60 distinct types of pediatric cancers, with leukemia and brain tumors being the most common. In France, around 2,300 children and adolescents under the age of 18 are diagnosed with cancer each year, including approximately 650 with leukemia and 550 with brain tumors. Unlike adult cancers, which can sometimes be caused by environmental factors, pediatric cancers are often linked to genetic or developmental issues. There are no known prevention strategies or screening methods for childhood cancers, although vaccines like the human papillomavirus (HPV) vaccine help prevent some adult cancers, such as cervical and oral cancers. Pediatric cancers tend to respond better to chemotherapy than adult cancers, leading to much higher cure rates. In France and Europe, the survival rate has increased from less than 30% to over 80%. However, about 20% of children and adolescents with cancer do not respond to standard chemotherapy, highlighting the urgent need for new treatments. The biology of childhood cancers is distinct from adult cancers, which means that targeted therapies and immunotherapies, which have been effective for adults, are not always applicable to children. The pharmaceutical industry typically requires a high return on investment, usually between 20% and 30%, to justify developing new drugs. However, because pediatric cancers affect a smaller population, the financial return is lower, leading to less investment in developing treatments specifically for children. Many chemotherapy drugs used in pediatric care do not have official approvals for use in children in the European market, which limits their availability and effectiveness. Despite significant advances in understanding the biology of pediatric cancers, there has been little progress in translating these findings into new treatments. For example, medulloblastoma, a type of brain tumor, was once thought to be a single disease, but recent research has shown it to be four distinct diseases with different biological characteristics and potential treatment options. However, no new drugs have been developed for children with the most aggressive forms of the disease. New European regulations are currently being considered that would require drug development for children based on the relevance of the treatment to pediatric conditions, rather than the presence of the same disease in adults. This change aims to eliminate exemptions that are not scientifically or medically justified.