14 August 2016
The odds are good that patients with low-risk Hodgkin lymphoma will conquer their cancer, but some treatment regimens may cause excessive toxicity. After closely examining clinical data on treatment outcomes, Ali Algiraigri at King Abdulaziz University Hospital and Mohammed Essa at King Abdullah Specialist Children Hospital in Saudi Arabia have concluded that it may be possible to minimize the risk of such harms while still maintaining a high cure rate1.
Hodgkin lymphoma is a cancer affecting white blood cells that is especially common in young adults. Data from Cancer Research UK indicates 66,000 new cases are diagnosed with the disease annually in the world. Many patients with early-stage disease receive a combination of chemotherapy and radiotherapy. The necessity of the latter remains the subject of considerable debate among clinicians because of the high risk of subsequent complications years down the line. This is particularly concerning because many patients are adolescents, with their whole lives ahead of them.
Algiraigri and Essa sought to clarify whether doctors could pursue less aggressive treatments in these patients without compromising patients’ odds for a full recovery. They analyzed published clinical trials in which adolescent patients received multiple rounds of various chemotherapy combinations, either with or without radiation therapy. “There are lots of regimens around the world to treat these patients,” says Essa. “In the end, the outcome is almost the same but with a different safety profile for each regimen and different complications.”
Their analysis showed that certain chemotherapy combinations with relatively mild side effects were sufficient to fully eradicate Hodgkin lymphoma on their own. Outcomes could be further improved by using results from positron-emission tomography (PET) to determine whether there is residual cancer that may require further treatment with radiation. In one key trial, this approach meant that three-quarters of patients could forego radiation therapy.
Essa notes that many experts in the field already avoid prescribing radiotherapy for their adolescent patients whenever possible, and that there are several on-going trials that aim to provide even more decisive support for this approach. “Avoiding radiotherapy will probably decrease certain long term side effects such as secondary malignancy and early cardiac disease,” says Essa.
Importantly, there are also several highly effective treatment options for use in case of recurrence, some of which might potentially be applied to further bolster chemotherapy efficacy. “The oncology field moves so fast,” says Essa. “Targeted therapies, like the drug brentuximab which is an important agent for post-relapse treatment, are now being tested as first-line therapies.” With more options at hand, it may not be long until radiation is only a last resort for early- and intermediate-stage Hodgkin lymphoma patients.
Algiraigri, A.H. & Essa, M.F. Management of Adolescent Low-Risk Classical Hodgkin Lymphoma: Which Chemotherapy Backbone Gives the Best Chance of Omitting Radiotherapy Safely. J Adolesc Young Adult Oncol. (2016).| article