Treatment of classical Hodgkin lymphoma in the era of brentuximab vedotin and immune checkpoint inhibitors

Abstract

The majority of Hodgkin lymphoma patients are now cured with conventional first-line therapy; however, 10-15% of early-stage disease and less than 30% of advanced-stage patients are refractory(rare) or relapsed. Salvage second-line therapy combined with high-dose therapy and autologous stem-cell transplantation can cure 40-50% of patients. Recently novel agents (Brentuximab Vedotin and Immune Checkpoint inhibitors) have demonstrated evidence of therapeutic activity and are potential bridge to an allogeneic stem-cell transplantation. The review is aimed to present not only salvage strategies; indeed, the paper contains paragraphs about therapy and new treatment options at diagnosis.

First‐line treatment of stage IIB to stage IV classical Hodgkin lymphoma in Italy, Israel, and Spain: Patient characteristics, treatment patterns, and clinical outcomes

“…However, patients with advanced stage cHL who fail to respond to front‐line therapy generally fare a poor prognosis. Outcomes for patients with relapsed or refractory cHL have greatly improved in the era of immunomodulatory and antibody‐drug conjugate therapies, but toxicity associated with long‐term treatment represents a considerable burden in these patients [ 2 ].…”

Metabolism and Immune Modulation in Patients with Solid Tumors: Systematic Review of Preclinical and Clinical Evidence

“…Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of solid and hematologic malignancies and have become a key therapeutic tool for the management of cancer patients. Different monoclonal antibodies targeting the programmed death 1 (PD-1) or PD-1 ligand (PD-L1) are currently used for the treatment of metastatic melanoma, non-small cell lung cancer (NSCLC), classic Hodgkin's lymphoma, urothelial bladder, renal cell and head and neck squamous cell carcinomas [1][2][3][4][5][6][7][8][9][10]. However, despite the impressive and long-lasting efficacy of these agents in a sizable subset of patients, only approximately 20-40% of patients benefit from ICIs, while in the majority of cases, tumors show primary resistance or undergo tumor progression after the initial response as a consequence of an acquired resistance (secondary resistance) [11].…”

Brentuximab vedotin in relapsed or refractory classical hodgkin lymphoma: real life experience in Norway 2011–2016

“…About 20% of patients with classical Hodgkin lymphoma (cHL) progress or relapse after first-line therapy [1,2]. Highdose therapy with autologous stem cell transplantation (ASCT) is the standard of care for patients responding to second line chemotherapy [3].…”