Neuroblastoma is the second most common solid tumor in infants and children. Improvement of therapy for stage IV patients remains the major goal of research in treatment of neuroblastoma. New approaches under study are focused in four main areas: (a) phase II studies; (b) mega-therapy procedures; (c) targeted therapy; and (d) immunotherapy. Future approaches will be closely linked to progress in laboratory investigation and more efficient use of currently available drugs. Of all the childhood malignancies, this is the one tumor where such an approach is most likely to be effective.