Meet the MSK Oncologist on a Quest to Cure Hodgkin Lymphoma with Fewer Long-Term Side Effects
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Meet the MSK Oncologist on a Quest to Cure Hodgkin Lymphoma with Fewer Long-Term Side Effects
Summary MSK medical oncologist David Straus is looking for less-intensive treatments for Hodgkin lymphoma, a type of blood cancer most commonly found in young adults. While cure rates for the disease are high, the standard treatment often results in serious side effects that can develop decades after treatment. Cancer in young adults is rare. When it does occur, one of the most common types is Hodgkin lymphoma. Cure rates are high, especially when the disease is detected early. But the standard treatment — usually a combination of chemotherapy and radiation therapy — often results in serious, long-term health problems that can develop 20 or more years after treatment.
Memorial Sloan Kettering’s David Straus, a medical oncologist who specializes in treating blood cancers including lymphoma, is focused on finding treatment regimens that have fewer side effects without compromising success rates.
In December, Dr. Straus presented a study at the American Society of Hematology (ASH) annual meeting that looked at using PET scans to monitor the presence of disease after initial treatment to help with decisions on additional treatment.
We spoke with him recently about that study and his work.
What is the current treatment for Hodgkin lymphoma? For early-stage disease, we use a chemotherapy regimen called ABVD, which is a combination of four drugs given together. Patients may receive up to six rounds of this treatment and may also get a course of radiation therapy — most commonly to the neck and chest, where many lymph nodes are located. This has been a standard treatment for at least 25 years, and it is effective in treating the disease, as shown by the high cure rates.
Patients who do not respond to or recur after initial therapy may undergo more intensive treatments, including bone marrow or stem cell transplantation using either their own cells or donor cells. This option also offers the possibility of a cure.
If the cure rates are so high, why is it important to find better treatments for this disease? In our most recent study, the average age of patients we treated was between 25 and 30, which is typical for people with Hodgkin lymphoma. The patients who are cured should be expected to live a long time. However, studies show that 40 years after treatment, only 25 percent of Hodgkin lymphoma survivors [those whose initial cancer was cured] are still alive. Almost all of the deaths are related to late complications of treatment, particularly radiation therapy.
The leading cause of death in Hodgkin lymphoma survivors is secondary cancers, which are usually related to radiation therapy, with an additional contribution of chemotherapy in some cases. Radiation therapy to the neck and chest area also can lead to cardiovascular damage, such as carotid stenosis, a narrowing of the arteries in the neck that can cause strokes; coronary artery disease; and scarring of the heart valves. Weakening of the heart — leading to heart failure — can be caused by both radiation and chemotherapy, and the risks are higher when both are used to treat the lymphoma.
There are other effects that don’t decrease patients’ life spans but can dramatically affect their quality of life, such as neck drop, which is a loss of nerve and muscle function in the neck that prevents a person from being able to lift his or her head.
