Last month, leaders from Children’s Oncology Group (COG) discussed the enormous progress in pediatric cancer research, from life-saving cures to new standards of care.
They also emphasized the challenges that remain in achieving COG’s vision of a future where no child or adolescent dies from cancer, and every survivor lives a healthy, fulfilling life. COG Group Chair, Dr. Douglas Hawkins, said, “Our goal has always been to cure childhood cancer. But we also have a responsibility to ensure that the treatments we develop give survivors the best possible chance at long, healthy lives. That means continuing to improve not only how effectively we treat cancer, but how safely we treat it.”
One area COG researchers consistently pursue is the reduction of the long-term effects of cancer treatments in children, adolescents, and young adults.
While advances in treatment have saved countless lives, some therapies can cause lifelong health problems, including damage to the heart.
These effects can range from changes in the heart’s ability to effectively pump blood to serious cardiovascular disease much later in life. COG researchers are working to reduce these risks by limiting exposure to potentially harmful treatments, protecting the heart during treatment, and studying the long-term benefits of those interventions.
Reducing Radiation Near the Heart: SWOG S1826
Chest radiation has historically been part of treatment for some children with Hodgkin lymphoma. Because chest radiation can also affect the heart, researchers have studied ways to avoid it safely.
In the recent SWOG S1826 clinical trial, conducted in collaboration with COG, nearly all participating adolescents and adults with advanced-stage Hodgkin lymphoma received treatment without radiation. In the most recent COG trial for advanced-stage Hodgkin lymphoma (AHOD1331), approximately half of patients received radiation.
The findings mark a promising advance in eliminating exposure to a common treatment associated with long-term cardiac complications, while maintaining cures.
Reducing Chemotherapy
Chemotherapy serves as the backbone of many childhood cancer treatment regimens, but certain chemotherapy drugs can also damage the heart.
Current studies, such as COG AHOD2131, seek to determine whether patients can safely receive fewer courses of conventional chemotherapy, including doxorubicin. This drug is an important component of treatment for several childhood cancers, including Hodgkin lymphoma, but can also affect heart function.
If successful, this approach could help reduce patients’ exposure to drugs associated with long-term cardiac effects.
When Chemotherapy Must Be Used, Protect the Heart
In some cases, chemotherapy drugs like doxorubicin remain essential to treating childhood cancer. To reduce the risk of heart damage, COG researchers have studied dexrazoxane, a medication given alongside doxorubicin to help protect the heart during treatment.
Earlier COG research led by Dr. Richard Aplenc and colleagues involving children with acute myeloid leukemia (AML) found that dexrazoxane helped preserve heart function without compromising cancer treatment outcomes. These findings have also helped inform clinical practice. A subsequent national study found that dexrazoxane use among children receiving treatment for AML increased substantially following the release of COG research supporting its benefits.
But an important question remained: Does the protection provided during childhood cancer treatment continue as patients grow older?
New Research Examines Long-Term Heart Protection
A new COG study, ALTE11C2, conducted by a research team including Dr. Erin Mobley, Dr. Eric Chow, and Dr. Steven Lipshultz and published in the Journal of Clinical Oncology in August 2026, offers insight into whether dexrazoxane’s benefits extend beyond childhood cancer treatment.
Researchers examined the heart health of 895 patients treated with doxorubicin, some of whom also received dexrazoxane. Using more than 2,000 heart ultrasound examinations collected over time, they found that patients who received dexrazoxane had better-preserved heart function years after their original cancer diagnosis.
The findings build on decades of research. Some participants were originally treated in clinical trials dating back to the 1990s, allowing researchers to revisit earlier findings and examine how heart function changed over time.
Beyond providing evidence of long-term heart protection, the study may also help inform how survivors are monitored for heart problems later in life. Patients who receive certain cancer treatments require ongoing cardiac screening, and researchers hope these findings will eventually help providers better understand individual risks and tailor long-term follow-up care. Dr. Mobley said, “It could provide some peace of mind for the family and the patient as they’re making difficult decisions.”
While additional research is needed to understand how these findings translate into cardiac health decades later, the study offers encouraging evidence that protecting the heart during childhood cancer treatment can make a difference well into survivorship.
Advancing Treatment, Protecting Futures
These studies are part of COG’s cumulative effort to address the long-term cardiac effects of childhood cancer treatment from multiple directions.
As this evidence continues to develop, it has the potential to inform both how childhood cancer is treated and how survivors are cared for in the years that follow.
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