With the aid of a recently awarded $3.5 million, five-year National Cancer Institute grant (R01CA262265), Rutgers Cancer Institute of New Jersey, New Jersey’s only NCI-designated Comprehensive Cancer Center, and Tufts Medical Center in Boston are collaborating on groundbreaking work that is unifying global multi-source big data in order to enhance clinical decision support for improved acute and long-term outcomes for Hodgkin lymphoma patients around the world.
Although Hodgkin lymphoma has good rates of overall disease control, there are many potential treatment options for patients and providers to consider. In addition, there is substantially increased risk of treatment-related late effects that occur throughout patients’ lives, such as cardiovascular disease, second cancers and compromised health-related quality of life. Due in part to these factors, significant debate remains about the optimal treatment for Hodgkin lymphoma patients in the modern era. Better tools to help inform individualized treatment and promote personalized cancer care are needed.
This current project will leverage the global HoLISTIC (Hodgkin Lymphoma International Study for Individual Care) consortium created in 2018 that is comprised of diverse, multidisciplinary experts who study aspects of Hodgkin lymphoma epidemiology, biology, prognosis, treatment, survivorship and health outcomes across all age groups. Through the HoLISTIC project – spearheaded by Andrew M. Evens, DO, MSc, FACP, associate director for clinical services at Rutgers Cancer Institute of New Jersey and system director of medical oncology, RWJBarnabas Health; and Susan K. Parsons, MD, MRP, medical director of the adolescent and young adult (AYA) program and research director of the Center for Health Outcomes at Tufts Medical Center – individual patient data from approximately 18,000 newly diagnosed Hodgkin lymphoma patients treated on prominent, contemporary clinical trials conducted around the world as well as granular data from prominent real-world registries is being used to create a large and detailed analytic database and common data model. This data model will be extensively tested in international survivorship cohorts and enriched with results from healthcare utilization databases.
In this next phase of this work, supported by the NCI grant, a study team of 35 worldwide investigators, led by Drs. Evens and Parsons, aims to determine point-of-care decision support models by harnessing individual patient data contained within the HoLISTIC consortium. To do this, the team will delineate new and modern disease prediction models, and estimate disease transition probabilities based in part on the types and amount of initial chemotherapy as well as positron emission tomography (PET) imaging response-adapted data to measure the contribution of early disease response. Augmented intelligence with simulation modeling to link cumulative doses of chemotherapy agents to estimate therapy-induced late effects, will also be used. This will all be synthesized into a robust clinical decision support model that projects likelihood of cure, life expectancy, late effects and quality-adjusted life expectancy for individual patients across varied treatment options.
“Delineating the most optimal therapeutic options that maximizes the cure of disease and concurrently minimizes the risk of late effects are important considerations in initial Hodgkin lymphoma treatment decision-making for individual patients,” notes Evens, who is also a professor of medicine and vice-chancellor of clinical innovation and data analytics at Rutgers Robert Wood Johnson Medical School, and a co-principal investigator on the grant. “This grant allows us to continue towards the creation of a dynamic decision support model for short-term disease outcomes and the projection of longer-term estimates of absolute risks of late effects and impacts on health-related quality of life for Hodgkin lymphoma patients.”
“In this project, we will enhance our prior decision model leveraging an international team of pediatric and adult cancer experts that are dedicated to harmonizing big data from clinical trials, real-world registries and survivorship cohorts,” notes Parsons, who is also professor of medicine and pediatrics at Tufts University School of Medicine, and co-principal investigator on the grant. “This new decision model also will incorporate new therapies and emerging knowledge of biologic predictors and imaging enhancements, which will advance our overall goal to better inform and improve clinical decision-making in this patient population.”
The results of this project will be significant, say the principal investigators, as they will inform Hodgkin lymphoma curability as well as long-term treatment-related late effects for individual patients across a variety of therapeutic options. The proposed decision-support model will be available to guide patients and clinicians at the time of initial diagnosis, relapse, and in survivorship care and also serve as a strong basis for future decision-support projects and health outcomes analyses.
