Thursday 1st December 2016

UK

In the past decade we have learned a lot more about how second cancers and heart disease affects young survivors of Hodgkin lymphoma. Major developments are being made in the field and today radiotherapy is no longer needed for a large portion of patients. Case studies like the one outlined below are crucial to improving the cure rate for Hodgkin lymphoma and understanding how we can improve quality of life after survival. 

Hodgkin Lymphoma in Teens and Young Adults

 Professor of Medical Oncology, Director of Research, Institute of Cancer Sciences University of Manchester, Manchester, UK

Improving outcomes for young people with cancer means better survival rates, improved quality of life, and reduced long term toxicity. In my research, I specifically look at Hodgkin lymphoma, a cancer that develops in the lymphatic system. It is one of the most common cancer diagnoses in teens and young adults. 

Cancer treatment has evolved considerably of the last 30 years, so much so that the majority of patients diagnosed are now able to be cured. But over the last decade, a considerably increased risk of second cancers and heart disease has been found in survivors of Hodgkin lymphoma because of the effects of chemotherapy and radiotherapy. Now, my team is asking how do we go about maintaining and even improving the cure rate and how do we simultaneously reduce the late toxicity which undermines both quality of life and survival?  

In 2015, our team published the results of a new trial, led from Manchester, where we showed that for patients with early stage Hodgkin's lymphoma, a normal PET scan (positron emission tomography) after three cycles of chemotherapy predicted for a very good outcome without further treatment. This means that radiotherapy is no longer required for a large proportion of patients with Hodgkin lymphoma. The results of this study is changing international guidelines and is predicted to drastically reduce the future incidence of second cancers and cardiac disease.    

But the results of the study will not benefit current Hodgkin survivors who have completed treatment in previous years - for these people, we need to develop ways of reducing the impact of second cancers and heart disease. The most common second cancer is breast cancer, so with the support of NHS England and Public Health England we have set up a single national database (BARD) of all women at risk as a result of radiotherapy involving breast tissue under the age of 36. This will initially involve 11,000 women in England and will make sure that all these survivors will receive appointments for screening at the right time. We believe this database will increase the detection rates of small, highly treatable breast cancers, reduce survivor anxiety and improve quality of life. We will be looking to fully understand radiation induced breast cancer, how to detect it better, and perhaps even prevent it altogether. 

At the upcoming ninth International Conference and first Global Adolescent and Young Adult Cancer Congress, I will be discussing the case of a 22 year old woman who developed a persistent cough and central chest discomfort in 2000. A chest X-ray showed a large mediastinal mass and urgent biopsy provided a diagnosis of classical Hodgkin lymphoma. She received chemotherapy and the lump reduced in size but did not completely disappear and so consolidation radiotherapy was recommended. She remained well for 10 years when breast screening revealed the presence of a small cancer in the right breast - this was successfully treated and she remains well but under careful surveillance.

This young woman's treatment took place before PET scanning was in routine use. Nowadays, it is likely that if after chemotherapy the PET scan was normal radiotherapy would not have been used and the chances of her developing breast cancer would have been reduced.

I am delighted to have been invited to speak on these topics at the 1st Global AYA Congress in Edinburgh hosted by Teenage Cancer Trust and look forward to seeing everyone there. It’s a wonderful opportunity for colleagues from around the world to share ideas and plan next steps in research and clinical practice. 

John will be speaking more on Hodgkin lymphoma in teens and young adults and our International Conference and Global AYA Cancer Congress taking place December 5-7 at the Assembly Rooms in Edinburgh, UK.

Register now to secure your place at the International Conference and Global AYA Cancer Congress