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Secondary Cancers in CLL Patients

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Published on February 26, 2021

What Should CLL Patients Know About Secondary Cancers? 

Are chronic lymphocytic leukemia (CLL) patients prone to secondary cancers? If a patient is diagnosed with a second cancer, where do they go from there? Does it affect their treatment regimen or quality of life? 

In this video replay from our “Dinner with the Docs” event on living with the CLL, two noted experts in the field address the important topic of secondary cancers, and offer first-hand advice to patients with CLL. Dr. Chris Benton, MD, and Dr. Paul (Tony) DeCarolis, MD, are both Medical Oncologists and Hematologists at Rocky Mountain Cancer Centers in Colorado. They are joined by Host and CLL Patient Advocate Carol Preston. Keep watching to learn more. 

Support for this series has been provided by Janssen Oncology and Pharmacyclics LLC. Patient Power maintains complete editorial control and is solely responsible for program content.

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Transcript | Secondary Cancers in CLL Patients

Carol Preston:  Welcome to Dinner with the Docs, with our CLL medical experts from the Rocky Mountain Cancer Center. Now here with us this evening are Dr. Chris Benton and Dr. Paul DeCarolis from RMCC.

Dr. Benton: Yeah, thanks for having me. My name is Chris Benton. I'm at Rocky Mountain Cancer Centers in southeast Denver and I'm a leukemia expert and a leukemia specialist.

Dr. DeCarolis: I'm Tony DeCarolis. I know it says Paul, but I go by my middle name, Tony and I've been in Colorado Springs with RMCC for, dare I say, over 20 years, we won't say exactly. And I treat all sorts of hematologic issues, including CLL and other diseases.

Carol Preston:  So, we want to just have one poll on getting a second cancer and so we're going to throw that up and you have three choices on that. Do you worry about getting a second cancer? Are you not worried? And have you gotten a second cancer? And I fall into that last category. Our poll shows that 21% of people do worry about it and nearly half have gotten a second cancer. The question is, do we know why? Do cancer cells jump? Can you talk a little bit about secondary cancers, what you've seen and what you tell your patients, Dr. Benton?

What Is the Likelihood of Developing a Second Cancer as a CLL Patient?

Dr. Benton: Pretty fascinating that nearly half the respondents had a second cancer. There is an association with dual malignancies. The largest study that I'm aware of was published around 2011, 2012 in one of the biggest cancer journals, Journal of Clinical Oncology, which did show an association between lymphoid malignancies and lung cancer. More recently, there has been an association, as you mentioned, between CLL and melanoma.

I don't have specific recommendations for my patients with regard to second cancer sort of monitoring, but I think maybe it's a good idea, especially with regard to the melanoma issue. I think one of the good things about seeing your oncologist regularly with CLL is that you can bring up other issues, the other things that come up. I don't know how your sarcoma was diagnosed, but perhaps seeing your oncologist kind of on a regular basis or seeing your dermatologist on a regular basis was something that led to that discovery. So, yeah, it is a real risk and it's something to be cognizant about with CLL.

Carol Preston: Yeah, I actually found it and brought it to the attention of my internist and we quickly went through some tests.

Dr. Benton: I was just going to get back to your second question also about whether or not the cancer jumps, so to speak. We don't think of it that the cancer can jump, but CLL is a cancer of immune cells and the immune system is very much involved in the regulation of sort of aberrant cancerous cells in the body or aberrant cells in the body. And so, there's some theories and some rationale for why patients with CLL might be at risk for other cancers, but we don't think that it would jump and just having a diagnosis of CLL does not guarantee a diagnosis of a second cancer or anything like that. The last thing I would mention is that there are some familial cases of CLL and this would be a reason, a dual cancer diagnosis or having a strong family history of cancer or CLL might trigger a genetics consult where genetics counseling could be done and maybe even some genetics testing.

Carol Preston:  Very, very interesting. Dr. DeCarolis, I wanted to ask you about CLL and other autoimmune diseases. For example, if I suffer from rheumatoid arthritis, would I get treatment for CLL? Which comes first, the chicken or the egg? You get treated for both? How do you work all of that?

What Happens When a CLL Patient Receives a Second Diagnosis?

Dr. DeCarolis: Yeah, that can be difficult if someone has two diagnosis that require treatments that involve the immune system, that can be a challenging situation, certainly in terms of which to treat, would often kind of come down to what is causing the most symptoms. If your CLL is relatively early and you can watch that and deal with something more problematic in your day-to-day life, be that lupus or rheumatoid and colitis, then that obviously is the priority with close monitoring of CLL. We know that changing the immune system can change how fast or slow CLL may evolve. Not sure that answers your question exactly, but that is a difficult situation when that comes up and does require a lot of communication.

Carol Preston: I also wanted to ask you, you mentioned Dr. Benton, familial issues and the question often arises as to whether CLL is hereditary. Will my sons need to be checked constantly because their mother has CLL? I'm wondering about some of the conversations you have with your patients as to their fears of discussing their cancer diagnosis or what they should tell their children or their immediate circle, whether it's work or friends.

Is Chronic Lymphocytic Leukemia Hereditary?

Dr. Benton: There's kind of different ways of thinking about hereditary cancers. One is, are you more at risk for this? And CLL happens to be a disease of a lot of patients of European descent. We see other types of lymphoma in patients of Asian descent, but we rarely see CLL actually in the Asian population. And so in that regard, there's probably some association with hereditary or ethnicity. That's different from having a cancer predisposition syndrome or a CLL predisposition syndrome, where there's a specific genetic factor that's responsible for multiple members of one family getting CLL. In most cases, that is not the case. In most cases, CLL is sporadic. It sort of is just by chance that someone would get it. But we're learning more about this.

Actually just in the recent past, in the past couple of years, where families with multiple cases of CLL have been identified and that genetic abnormality, that specific gene that is responsible in those cases is identified. You also mentioned about patients with rheumatologic disease or other immune mediated disease, and I do find patients with CLL have other immune mediated disease, oftentimes rheumatologic disease. And sometimes this kind of runs in families, but there's not a specific genetic component. It's probably a constellation of genetic components that contribute to this. And so, yeah, this is where we rely on the genetics counselors and sometimes they can do testing. They sometimes test now for hundreds of genes in order to try and identify if there's something that predisposes you specifically to getting cancer or to getting CLL.

Carol Preston: Before we sign off, I want to ask each of you, what you're optimistic about for CLL down the line, in the future? It's still an incurable disease. Starting with you, Dr. Benton and then Dr. DeCarolis, you will get the last word on that. Dr. Benton, what are you optimistic about at this point?

What Are You Optimistic About for the Future of CLL Research and Treatment?

Dr. Benton: Just in my short many years career I have seen so much change in leukemia and blood cancers that I would say we have a lot to be optimistic about. There's been an explosion of therapies for leukemias and lymphomas and cancers in general. And because of that, I think that the future is brighter than you think. I mentioned these various leukemias that are in many cases cured now and I think that in CLL that is also nearby. I think it's right around the corner. 

Carol Preston: That's very exciting. And Dr. DeCarolis?

Dr. DeCarolis: Well, I'm optimistic primarily over my career as I age and get to age with patients that have been treated, who are functioning, and so I'm optimistic talking to you and survivors of this length of time who are functioning at a normal level. And I think that's only going to continue to increase over time. Quite frankly, our treatments are less dangerous than they've been in the past and the patients that I've aged with are doing wonderfully and get to see grandchildren and get to do things, go to graduations and weddings and things like that. And so I agree with Chris, we're only going to have more progress in the years to come.

Carol Preston: Well thank you. You both give me great hope.

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