Lenalidomide and Secondary Cancers

Since I've been thinking and writing about secondary cancers lately, I thought I'd share this: "Second primary malignancies in patients with haematological cancers treated with lenalidomide: a systematic review and meta-analysis," published a couple of days ago in The Lancet Haematology.

I'll give you the good news up front -- Lenalidomide doesn't seem to cause secondary cancers in Follicualr Lymphoma.

Lenalidomide is also known as Revlimid, and it is the second "R" (along with Rituxan) in the combination R-Squared. This treatment is, of course, an important option for Follicular Lymphoma patients, since it is the first non-chemotherapy treatment that has been shown to be as effective and safe as traditional chemo like R-CHOP or B-R. Safety is important -- in the study that compared R-Squared to chemo, it was found that R-Squared had about the same amount of side effects, but different ones. 

One long-term side effect of any cancer treatment is the potential for developing secondary cancers -- a new cancer other than the one being treated. They happen, because many cancer treatments work by affecting the DNA of cancer cells, and sometimes normal cells, too. When a normal cell's DNA is changed, it can change in bad ways, making it hard for the cells to die a natural death, and thus become cancer cells.

So that brings us to the Lancet article.

Lenalidomide has been used for a while to treat Multiple Myeloma, another blood cancer that shares some characteristics with FL. It can grow slowly, for example. When I was a guest on the No Better Time Than the Present series (see the YouTube video here), I talked a little bit about how much I could connect with my host Yolanda's experience as a patient with Multiple Myeloma. Yolanda watched and waited for 5 years before treatment, for example, way more than my 2 years.

Whole Lenalidomide can be effective for for Multiple Myeloma, several studies have shown that it increases the the chances of secondary cancers for MM patients. But, as the researchers say, there hasn't been a careful look at whether Lenalidomide increased the chance of secondary cancers for other blood cancers and blood disorders that use it as a treatment.

So they did what's called a meta-analysis. Instead of running a brand new clinical trial, they looked back at the data from every bit of research they could find that studied Lenalidomide. They found a whole bunch -- 38 trials that included 14,058 patients, including 18 trials with patients with Multiple Myeloma.This allowed them to compare MM with other blood cancers.

The results were kind of fascinating. Patients with MM had a higher incidence of secondary cancers, both new blood cancers and new solid cancers. But patients with other blood diseases -- lymphoma, CLL, or myelodysplastic syndrome -- had no increased chance of secondary cancer. 

That's good news for us. I can only see the abstract of the article, not all of the data, so I don't know if they broke out Follicualr Lymphoma studies specifically. But I don't think that matters for the results. At least according to research that has already been published, Lenalidomide does not increase our chances of a secondary cancer. 

It's not good news for Multiple Myeloma patients, of course, and I feel for them. But I also find it fascinating that there is something about MM that mixes with the mechanisms of Lenalidomide that just isn't present in FL or other lymphomas. I'm sure lots of Lymphoma experts will find that even more fascinating, and that's great news. A new line of research that might help them understand MM a little bit more.

One less thing to worry about....