Other needs include integral biomarkers to enable early identification of refractory patients, continued investigation into the use of biologically based targeted agents, expansion of trials of novel agents to adolescents aged 12 to 15 years, and novel salvage regimens for the 15% to 30% of children with recurrent or refractory disease.1 Following favorable results in adults, the use of nivolumab is currently being investigated in pediatric trials in combination with brentuximab vedotin for relapsed HL (ClinicalTrials.gov Identifier: NCT02927769) and in combination with brentuximab vedotin and ipilumumab for relapsed/refractory lymphoma (ClinicalTrials.gov Identifier: NCT01896999).
Additional areas that warrant further examination in pediatric populations include the use of pharmacogenomics to personalize treatment based on genetic risk for various late-treatment sequelae, the use of cardioprotective agents with primary therapy to minimize cardiovascular risk, pretreatment preservation of fertility in adolescents, the effects of fatigue and health-related quality of life on long-term outcomes, and the financial and societal costs associated with pediatric HL.1
The researchers also emphasized the importance of secondary prevention in pediatric HL, including risk-based screening and intervention for the various medical and psychosocial morbidities that can affect survivors many years after initial treatment.1 Thus far, the International Guideline Harmonization Group for Late Effects of Childhood Cancer has created guidelines pertaining to screening and treatment for breast cancer, cardiomyopathy, premature ovarian insufficiency, male gonadotoxicity, thyroid cancer, and ototoxicity.7
“Bridging the survivorship gap will be attained with enhanced knowledge of and attention to biology of the tumor and microenvironment, host genetic factors, health-related quality of life, and subpopulations with disparate outcomes,” the researchers concluded.1
For clinical perspectives on the topic, Hematology Advisor interviewed Shana S Jacobs, MD, of the Leukemia/Lymphoma Program at Children’s National Hospital in Washington, DC, and Lia Gore, MD, section head of pediatric hematology, oncology, and bone marrow transplant at Children’s Hospital Colorado in Aurora.
Hematology Advisor: What are the reasons for the survivorship gap in children and adolescents with HL?
Dr Jacobs: The “survivorship gap” refers to the gap between the immediate cure of HL and the longer-term morbidity and mortality from late effects that affect survivors of pediatric HL. This occurs because many of the treatments confer serious long-term sequelae that affect both quality of life and life span, including cardiac effects, pulmonary toxicities, and secondary neoplasms.
Dr Gore: Overall, there is a gap in survivorship for the adolescent and young adult population with many cancers because this population often falls within the gap between pediatric and adult care. Adolescent and young adult patients don’t feel comfortable in a waiting room with 3-year-olds, but they feel similarly uncomfortable in a practice surrounded by patients who look and act like their parents or grandparents – which is the bulk of [patients at] adult oncology practices – so sometimes they just don’t show up and, therefore, they don’t get optimal therapy.
In addition, the supportive services offered in most adult oncology practices are typically fewer [in quantity] and less accessible compared with those offered in pediatric practices. If a patient doesn’t follow up with us, we call them and find out where they are and get them in for treatment. If they don’t show up for an appointment in an adult center, often there are minimal resources to try to track them down and get them in for treatment. There are simply too many patients to do this reliably.
This article originally appeared on Hematology Advisor