Posted: December 12, 2017

Oncologists have been aware since the field was born in the 1960′s that there were short-term and long-term side effects from the treatments they deliver.  As drug treatments get better and more people are cured of advanced cancer, the long-term side effects become even more worrisome.  Now comes an article from a journal called ESMOopen (ESMO is the European Society of Medical Oncology) published by the British Medical Journal that looks critically at published studies to try to get a grip on the nature and magnitude of the problem.   Click here  for a link to the abstract.  Dr. Stark can provide the full article if you fill out the form on the right and ask him for it.  He cannot link to the full content directly because of copyright issues.  Here is what the authors found.

The one side effect known for a long time is second malignancy.  From the earliest days of treatment with melphalan and cyclophosphamide for breast cancer and myeloma Oncologists recognized that a small percentage of these patients would develop acute myeloid leukemia.  Because of this, these drugs are used much less often today.  People treated successfully for Hodgkin lymphoma have a much higher than predicted incidence of non-Hodgkin lymphoma.  These findings were re-affirmed.   In addition, however, other non-malignant side effects are seen with alarming frequency.  They include endocrine (hormonal) dysfunction (seen very often with immune checkpoint inhibitors — new and very potent cancer drugs); lung fibrosis (scarring) seen with many different drugs, made worse if doctors don’t look carefully for it as treatment is ongoing; heart damage, osteoporosis and what they term frailty (failure to recover constitutionally from the effects of the treatment).   The authors review the mechanisms for this, including telomere damage, DNA damage, chronic low-grade inflammation and epigenetic alterations (adding side chains to DNA strands that make them prone to malfunction).

Dr. Stark weighs in: “We have known for a long time that when it comes to cancer treatment there is no free lunch.  With heightened recognition it is likely that Onclogists will find ways to ameliorate these symptoms with early intervention.   This could even involve gene splicing to repair damaged DNA.  Stay tuned….”