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Revlimid Raises Secondary Cancer Risk for Second Primary Malignancies

Posted May 14 2012 12:00am

A new subdiscipline within oncology is getting increased attention -- survivorship (see: Cancer Survivorship, an Emerging Subdiscipline in Oncology ; Cancer Survivorship and the Role of PCPs in Continuing Care of Cancer Patients ). As cancer increasingly comes to be viewed as a chronic disease, more attention is being paid to the long-term medical problems of cancer survivors such as the drug damage to normal organs and also new cancers secondary to cancer therapy. Here's an account of second primary malignancy risk due to Revlimid (see: Cancer drug Revlimid (lenalidomide) raises secondary cancer risk ). Below is an excerpt from the report:

The U.S. Food and Drug Administration (FDA) is informing the public of an increased risk of second primary malignancies (new types of cancer) in patients with newly-diagnosed multiple myeloma who received Revlimid (lenalidomide). Clinical trials conducted after Revlimid was approved showed that newly-diagnosed patients treated with Revlimid had an increased risk of developing second primary malignancies compared to similar patients who received a placebo. Specifically, these trials showed there was an increased risk of developing acute myelogenous leukemia, myelodysplastic syndromes, and Hodgkin lymphoma. 

Revlimid is used to treat newly-diagnosed multiple myeloma so its target is, obviously, plasma cells and their precursor cells. It's probably no surprise, therefore, that other myelopoietic and lymphopoietic cell lines could be affected by this drug. All of these cells have a high turnover rate in the bone marrow and lymph nodes. Here's an excerpt from the summary of a scientific article published in Sweden to give you some idea of the scope and scale of second primary neoplasms among patients with haematolymphoproliferative malignancies (see:  Second primary neoplasms among 53 159 haematolymphoproliferative malignancy patients in Sweden, 1958–1996: a search for common mechanisms ):

The Swedish Family-Cancer Database was used to analyse site-specific risk of second primary malignancies following 53,159 haematolymphoproliferative disorders (HLPD) diagnosed between 1958 and 1996....Among 18 960 patients with non-Hodgkin’s lymphoma (NHL), there was over a 3-fold significant increase in cancer of the tongue, small intestine, nose, kidney and nervous system, squamous cell carcinoma (SCC) of the skin, NHL, Hodgkin’s disease (HD) and lymphoid and myeloid leukaemia. Among 5353 patients with HD, there was over a 4-fold significant increase in cancer of the salivary glands, nasopharynx and thyroid, NHL and myeloid leukaemia, and over a 1.6-fold increase in cancer of the stomach, colon, lung, breast, skin (melanoma and SCC), nervous system and soft tissues and lymphoid leukaemia. Among 28 846 patients with myeloma and leukaemia, there was a significant increase in cancer of the skin, nervous system and non-thyroid endocrine glands and all HLPD except for myeloma.

There are at least three explanations for second primary neoplasms among patients with haemato-lymphoproliferative disorders: a genetic predisposition to later malignancies, lifestyle issues, and the lingering effects of treatment for the first  neoplasm. What is certain, however, is that surveillance for secondary neoplasms among these patients needs to be in high-gear. My own view is that such surveillance is best accomplished in specialized cancer centers but I think that many such centers may view their mission as emphasizing treatment over surveillance. However, this attitude is now being modified with greater emphasis on cancer survivorship. This is a welcome change.

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