Targeted therapy in this pediatric cancer reduces relapse rates

On Nov. 3, the New England Journal of Medicine published a paper that described how children with high-risk Hodgkin lymphoma responded to a targeted therapy for the disease that has been effective in adults. Conducted by the Children’s Oncology Group (COG) and led by pediatric oncologists at Roswell Park Comprehensive Cancer Center, Children’s Healthcare of Atlanta and Winship Cancer Institute of Emory University, the trial found that the therapy was shown to significantly reduce relapse rates when tested in a large multicenter clinical trial.

Kara Kelly, division chief of hematology/oncology in the Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, and chair of the Roswell Park Oishei Children’s Cancer and Blood Disorders Program, was senior author on the study. She is also Waldemar J. Kaminski Endowed Department Chair of Pediatrics and professor of pediatric oncology at Roswell Park.

In a conversation with UBNow, Kelly discusses the importance of the study, what it means for families affected by this disease in Buffalo and how her dual appointments at Roswell and UB are helping to improve the care of children with cancer.

These are children with high-risk, advanced stage Hodgkin lymphoma. Since the 1960s, there have been numerous improvements in the survival of children with various cancers and survival rates have steadily improved, but with this cancer there haven’t been major breakthroughs. These children have inferior outcomes from a disease control perspective. In addition, they’re at higher risk of dying from secondary cancers and cardiovascular disease. Both the disease and side effects from chemotherapy put them at risk for infertility and other long-term complications from treatment.

The result from our study was a nearly 10% improvement in event-free survival. That’s quite a big gain, especially in this field. We are optimistic that this treatment regimen will become standard of care.

In addition, the New England Journal of Medicine hasn’t published about this disease in decades. The fact that NEJM is publishing this one reflects the importance of this breakthrough.

Through this collaborative network, we designed a phase 3 randomized controlled trial. We took the standard six-drug therapy with radiotherapy and modified it using a targeted immune-oncologic drug used for Hodgkin lymphoma in adults. It targets a protein on the surface of the Hodgkin cell.

As chief of the Division of Hematology/Oncology in the Department of Pediatrics at the Jacobs School, I lead the joint program in pediatric oncology with Roswell Park. Half of the faculty in my division are employed by UB. It really is a joint program, a program where physicians, clinicians and investigators are employed by either institution, but all are involved in both research and patient care. It’s very much a collaborative program between UB, Roswell Park and Oishei Children’s Hospital.

The grant that is funding this research was awarded to UB from the Children’s Oncology Group, which is supported by the National Cancer Institute. My support from UB provides me with the time to pursue clinical trial research. In this way, UB supports me to work collaboratively with groups across North America.

This trial was one of the largest phase 3 immuno-oncologic trials in pediatrics with patients who are newly diagnosed. It’s a pretty significant trial because of that. We really are leading the way.

In our trial, we saw what we call event-free survival, where the child survives and doesn’t relapse or develop a second cancer. That’s significant and even more important in this younger population, so that we can reduce exposure to standard chemotherapy and radiation, both of which have significant long-term toxicities.

Out of a total of 600 patients enrolled across 153 pediatric cancer programs in North America, this trial in Western New York was able to enroll nine, a significant number given that Buffalo is a smaller city than other major cities where the trial was enrolling patients.

Our patients and their families were receptive to enrolling. That fact speaks to our community’s commitment to clinical research and to the success of the collaborative program we have developed here in Buffalo. It allows us to offer really novel therapies to our patients that translate into significant improvement and survival so that pediatric patients don’t have to leave our area to get the best treatment.

I’m very invested in being able to leverage all the great resources we have at UB, at Roswell and at Oishei. It is so important to these families that they can get all their care right here in their own community.