Despite advances in cancer treatments, people who underwent chemotherapy for a solid tumor between 2000 and 2014 were still at greater risk of developing a rare chemotherapy-related blood cancer.1
Advances in the treatment of cancer have led to more people surviving many forms of the disease than ever. But they are also at risk of developing rare potential side effects of toxic chemotherapy.
An example of this is therapy-related myelodysplastic syndrome/acute myeloid leukemia (tMDS/AML).
“We’ve known for a long time that the development of myeloid leukemia is a very rare adverse effect of some types of cancer treatments that damage cells,” says Lindsay Morton, Ph.D., lead author of the study and a senior investigator at the National Cancer Institute’s (NCI) Division of Cancer Epidemiology and Genetics.
“There have been many changes in cancer treatment over time, including the introduction of new chemotherapy drugs and drug combinations, but we didn’t know what the risk of therapy-related leukemia looked like for patients since these changes were made.”2
The team analyzed data from the NCI’s Surveillance, Epidemiology, and End Results (SEER) program and the SEER-Medicare database.
From the SEER program, they looked at 700,612 people aged between 20 and 84 who had survived for at least one year after undergoing chemotherapy for a first, primary solid cancer. They were all diagnosed between 2000 and 2013 and followed up through 2014.
To ascertain which treatments were most commonly used, they also analyzed the records of 165,850 adults aged between 66 and 84 listed on the SEER-Medicare database. All the patients had received initial chemotherapy for a first, primary solid cancer between 2000 and 2013.
The data analysis was carried out between October 2017 and April 2018.
Of the more than 700,000 patients treated between 2000 and 2013, 1,619 had developed tMDS/AML by the end of 2014. Of these, 1,270, or 78.4%, had died within the window of the study with a median survival of just seven months.
Compared to the general population, the risk of developing tMDS/AML was between 1.5 and 10 times higher for 22 of the 23 solid cancer types investigated. The exception was colorectal cancer.
The analysis of the SEER-Medicare database found a substantial rise in use of platinum-based chemotherapy agents, which are known to increase the risk of tMDS/AML. Their use grew from 57% of patients in 2000-1 to 81% of patients in 2012-13.
“The most important message from this study is that, while advances in cancer treatment approaches have improved the prognosis for many types of cancer, the number of patients at risk of developing rare, therapy-related leukemia after cancer chemotherapy in the modern treatment era has markedly expanded,” Dr. Morton observes.
“Assessments of treatment risks and benefits should balance these risks and other adverse effects of chemotherapy against potential gains in survival following treatment for the initial solid cancer.”2
The authors noted that their study showed continued efforts to minimize exposure to leukemia-causing chemotherapy agents and developing effective and less toxic chemotherapy options were “critical”.
Morton LM, Dores GM, Schonfeld SJ, Linet MS, Sigel BS, Lam CJK, et al. Association of Chemotherapy for Solid Tumors With Development of Therapy-Related Myelodysplastic Syndrome or Acute Myeloid Leukemia in the Modern Era. JAMA Oncol 2018. doi: 10.1001/jamaoncol.2018.5625. [Epub ahead of print].
- Morton LM, Dores GM, Schonfeld SJ, Linet MS, Sigel BS, Lam CJK, et al. Association of Chemotherapy for Solid Tumors With Development of Therapy-Related Myelodysplastic Syndrome or Acute Myeloid Leukemia in the Modern Era. JAMA Oncol doi: 10.1001/jamaoncol.2018.5625. [Epub ahead of print].
- (2018) Study finds elevated risk of certain rare blood cancers after chemotherapy for most solid tumors [Press release]. December 20, 2018. Available from https://www.nih.gov/news-events/news-releases/study-finds-elevated-risk-certain-rare-blood-cancers-after-chemotherapy-most-solid-tumors (accessed April 2019).