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WHAT WAS LEARNED?
Hematologist/oncologist Syed Rizvi, MD, assistant professor at the Harold C. Simmons Comprehensive Cancer Center at the University of Texas (UT) Southwestern in Dallas, said North American and European Groups do not operate as silos. Now more than ever there is cross talk between different cooperative groups, and they have learned immensely from each other and made remarkable strides.
“There are some differences between risk stratifications and perhaps thresholds to use aggressive regimens like BEACOPP [bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone] are higher in North America. But when you look at the forest instead of the trees, both sides want to achieve better survival outcomes with the least amount of toxicities,” Dr Rizvi told Oncology Nurse Advisor.
He said PET imaging approaches are being increasingly utilized in North America, and patients with suboptimal PET-based responses mid treatment are escalated to more robust regimens such as BEACOPP. In addition, clinicians in North America have learned to abbreviate treatments, thanks to European studies in which chemotherapy exposure for some patients with early stage/good risk classical Hodgkin lymphoma is minimized.
IMPLICATIONS FOR NURSES
Dr FitzGerald and coauthor contend there is now a window of opportunity to improve patient management. They write that worldwide trials have the potential to greatly improve the understanding of Hodgkin lymphoma and enhance patient management. Dr Rizvi sees oncology nurses as instrumental in recognizing unique complications in this patient population.
Bleomycin, for example, may lead to lung toxicity and early recognition may help prevent untoward outcomes. Incorporating newer agents such as brentuximab upfront leads to unique adverse events such as neuropathy, which can be debilitating if not addressed in a timely manner, explained Dr Rizvi.
Outpatient BEACOPP is a more complex and involved regimen that requires coordination between physicians, nurses, and pharmacists to be delivered safely. It has higher rates of complications such as infections in the setting of neutropenia. This may require prophylactic antimicrobial treatments, growth factor support, and clinical vigilance, according to Dr Rizvi.
Checkpoint inhibitors (eg, nivolumab, pembrolizumab) are increasingly used to treat relapsed/refractory Hodgkin lymphoma and have unique adverse effects ranging from hypophysitis to proctitis, Dr Rizvi explains. Novel therapies such as CD-30 chimeric antigen receptor (CAR) T cell therapy are increasingly available, and cytokine release syndrome (CRS) is a common manifestation of this therapy. These patients may present with fevers, noninfectious inflammation, and confusion.
“These are exciting times for us and our patients, but we need to be prepared to recognize and address some of these unique complications early, so that patient outcomes continue to improve,” said Dr Rizvi.
John Schieszer is a medical writer based in Seattle, Washington.
Reference
FitzGerald TJ, Bishop-Jodoin M. Hodgkin lymphoma: differences in treatment between Europe and the United States/North America: evolving trends in protocol therapy. Clin Med Insights Oncol. 2018;12:1-12.
