Optimizing Clinical Outcomes Through Multidisciplinary Collaboration

CancerNetwork spoke with Andrew M. Evens, DO, MBA, MSc, deputy director for clinical services at the Rutgers Cancer Institute and system director of medical oncology and oncology lead at RWJBarnabas Health Medical Group, about how cross collaboration between pediatric and adult oncology experts has impacted treatment for adolescent/young adult (AYA) patients with lymphoma.

Evens highlighted a trend in the lymphoma landscape, wherein the most common age observed for Hodgkin lymphoma is in the late 20s and early 30s, which falls within the bounds of the AYA designation. He continued by contrasting progress overall progress for lymphoma across all age groups, but a notable lag in AYA patients with lymphoma.

Evens continued by expressing that pure pediatrics, or those under 18, and adults 40 years and older have seen notable improvements in their outcomes, that has not been observed in the AYA group. Explaining that the precise reason why AYA lymphomas have experienced a lag, he stated that it was important to identify and rectify this unmet need among this patient population.

Evens then highlighted efforts undertaken by the Lymphoma Research Foundation, which sought to improve outcomes in AYA lymphoma. Starting with a symposium in 2015, Evens explained that they laid the groundwork for further research and subsequent symposiums, ultimately leading to a consortium specifically designated for AYA lymphoma. Evens explained that this symposium was paramount in identifying and understanding unmet needs among this patient population, as well as prioritizing research to effectively address them.

Transcript:

The most common age that we see classic Hodgkin lymphoma, in this case––and I am talking about classical Hodgkin [lymphoma]––is in your late 20s, around age 30––right squarely in the AYA [adolescents or young adults with lymphoma]. In other words, most patients with classical Hodgkin lymphoma are AYA, and that is why it was so important to bring the leaders together. Even though there has been great progress across the aisle for all ages, there has been an interesting and unknown [...] lag for AYAs.

When we look at progress over the last 15 to 20 years—I am using classical Hodgkin lymphoma as an example—there have been big improvements for patients younger than 18 years—so pure pediatrics—and patients greater than 40, 50, or 60 years. Yes, there has been progress for the AYA patients, but less than for the pediatric and older patients. We do not know why, and it is [likely] complex. Does it include disease biology, social factors, access to appropriate clinical care? This is really important to understand it and to hopefully address this unmet need of AYA lymphoma. I have been giving classic Hodgkin lymphoma, but there are other AYA lymphomas––B-cell lymphomas, T-cell lymphomas––with the same problem to really understand it.

Thankfully, the Lymphoma Research Foundation has been laser focused on this unmet need of AYA lymphomas. They initially convened a symposium in 2015 to [better] understand it. It was a symposium of clinicians, pediatric and adult oncologists, basic scientists, epidemiologists––a paper was published in 2017 in Blood Advances––state of the state.

Then the Lymphoma Research Foundation continued this. There was another general educational symposium in 2019 then it really started to hit some steam in 2022 into 2023 where they formally established an adolescent/young adult or AYA lymphoma consortium. That is meaningful because for as long as the foundation has existed, they only have a handful of dedicated consortiums, and when they establish a formal consortium, it is one they intend to galvanize, hopefully not just in North America but the world, in understanding these unmet needs, whether through education, science, or more research dollars to understand it. [Additionally, it is] to have an intellectual understanding of all the different areas, to say, not just, “What are the gaps in knowledge?” but “How do we prioritize for research funding and discoveries for AYA lymphomas?”