– Courtesy Photo
By Joyce Peng
Today, patients with childhood cancer have a better chance of surviving than before, due to better treatment. In the US, there are 400,000 survivors of childhood cancer, Dr. Saro Armenian, a pediatric oncologist and a clinical researcher at City of Hope Duarte, said. Yet, as these survivors age into adulthood, the very same treatments that saved their lives can cause significant health complications.
Health complications, developing five or 10 years down the line, include the development of other cancers, problems in the lungs and thyroid, fertility issues, hormonal changes and cardiovascular complications. Heart failure can occur in survivors who have been treated with high doses of certain types of chemotherapy. Unfortunately, they tend to develop it much earlier than the general population, in their 20s and 30s, when they still have a long life ahead of them.
There is not one type of drug that drives these complications, Armenian noted. It’s a multi-modal approach with many different drugs, radiations, surgery and bone marrow transplant (BMT) that cause complications. Some patients develop complications from one specific drug and others from multiple treatments methods. Anthracyclines, a drug used in chemotherapy, is linked with a risk of heart failure – the higher the dosage, the higher the risk. Risk also increases in survivors who received anthracyclines along with radiation where the heart is in the treatment field.
“We try to balance both treatment and strategies to maintain a healthy lifestyle after treatments,” Armenian voiced.
Armenian’s primary study as a clinical researcher is the long term effects cancer has on the cardiovascular system in the aging population of survivors. His current study is testing whether a low-dose blood pressure medication could be used as an early prevention strategy for individuals who have a high risk of developing heart failure.
The study randomizes subjects in half, one half receiving a placebo and the other the actual drug. For two years, the participants will take the drugs while Armenian and his team monitor them. The low-dose blood pressure medication, known as Carvedilol, has been around for decades and used by many people to treat high blood pressure and prevent heart failure.
“The drug has never been used in this context before,” Armenian explained. “We use a lower dosage to minimize the side effects to protect the heart. The drug is safe and well tolerant.”
Armenian mentioned that two foundations, St. Baldrick’s Foundation and the Leukemia & Lymphoma Society, have contributed funds to his study.
St. Baldrick’s Foundation is a volunteer-powered charity based in Monrovia that funds the most promising research to find cures for childhood cancers and to give survivors long, healthy lives. Survivorship is one of its focus areas for funding. It has contributed $262,088 to Armenian’s study, St. Baldrick’s Foundation Media and PR Manager Traci Shirk said.
City of Hope is the coordinating center among the three institutions working on this study: City of Hope, St. Jude Children’s Research Hospital in Memphis and the University of Michigan. His team’s plan is to have the study open within the children’s oncology group, which coordinates research across more than 200 institutions in North America.
Armenian and his team is currently looking for participants who received high doses of anthracyclines, are off treatment or therapy, and are at least 16 years old at the time of enrollment. They started recruiting a couple of years ago, and there are already participants enrolled on the study who are taking the drug.
If Armenian’s study is successful, its information can be used to help avert the onset of treatment-related heart failure after completion of therapy. Additional risk reduction strategies being explored include: reducing the total doses of treatment given to children with cancer, as well as designing better drugs that specifically target the cancer cells in order to minimize the toxicity to non cancer cells.
Armenian noted that as oncologists, they do not stop once treatment is over.
“We continue to study survivors,” Armenian said. “We are committed to patients after cancer and want them to live long and healthy lives.”
