Advanced stages of classical Hodgkin lymphoma – first-line treatment options

Czech version

Authors: H. Mociková
Authors‘ workplace: Hematologická klinika 3. LF UK a FN Královské Vinohrady, Praha
Published in: Klin Onkol 2021; 34(6): 450-454
Category: Review
doi: https://doi.org/10.48095/ccko2021450

Overview

Background: Advanced stages of classical Hodgkin lymphoma can be cured by the first-line treatment in 80% of patients. Conventional treatment options include ABVD chemotherapy (doxorubicin bleomycin, vinblastine, dacarbazine) or escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) are commonly used in advanced stages. The result of interim positron emission tomography allows adjustment of the treatment intensity during chemotherapy and this approach can affect the treatment results and toxicity. Purpose: This review summarizes current options of conventional chemotherapy and implementation of brentuximab vedotin and PD-1 inhibitors in combination with chemotherapy into the first-line treatment.

Keywords:

nivolumab – Hodgkin lymphoma – brentuximab vedotin – Chemotherapy – pembrolizumab

Sources

1. Mulder TA, Wahlin BE, Österborg A et al. Targeting the immune microenvironment in lymphomas of B-cell origin: from biology to clinical application. Cancers (Basel) 2019; 11 (7): 915. doi: 10.3390/cancers11070915.

2. Hasenclever D, Diehl V. A prognostic score for advanced Hodgkin’s disease. International prognostic factors project on advanced Hodgkin’s disease. N Engl J Med 1998; 339 (21): 1506–1514. doi: 10.1056/NEJM199811193392104.

3. Johnson P, Federico M, Kirkwood A et al. Adapted treatment guided by interim PET-CT scan in advanced Hodgkin’s lymphoma. N Engl J Med 2016; 374 (25): 2419–2429. doi: 10.1056/NEJMoa1510093.

4. Stephens DM, Li H, Schöder H et al. Five-year follow-up of SWOG S0816: limitations and values of a PET-adapted approach with stage III/IV Hodgkin lymphoma. Blood 2019; 134 (15): 1238–1246. doi: 10.1182/blood.2019000719.

5. Borchmann P, Haverkamp H, Lohri A et al. Progression-free survival of early interim PET-positive patients with advanced stage Hodgkin’s lymphoma treated with BEACOPP escalated alone or in combination with rituximab (HD18): an open-label, international, randomised phase 3 study by the German Hodgkin Study Group. Lancet Oncol 2017; 18 (4): 454–463. doi: 10.1016/S1470-2045 (17) 30103-1.

6. Borchmann P, Goergen H, Kobe C et al. PET-guided treatment in patients with advanced-stage Hodgkin’s lymphoma (HD18): final results of an open-label, international, randomised phase 3 trial by the German Hodgkin Study Group. Lancet 2017; 390 (10114): 2790–2802. doi: 10.1016/S0140-6736 (17) 32134-7.

7. Kreissl S, Goergen H, Buehnen I et al. PET-guided eBEACOPP treatment of advanced-stage Hodgkin lymphoma (HD18): follow-up analysis of an international, open-label, randomised, phase 3 trial. Lancet Haematol 2021; 8 (6): e398–e409. doi: 10.1016/S2352-3026 (21) 00101-0.

8. Casasnovas RO, Bouabdallah R, Brice P et al. PET-adapted treatment for newly diagnosed advanced Hodgkin lymphoma (AHL2011): a randomised, multicentre, non-inferiority, phase 3 study. Lancet Oncol 2019; 20 (2): 202–215. doi: 10.1016/S1470-2045 (18) 30784-8.

9. Younes A, Connors JM, Park SI et al. Brentuximab vedotin combined with ABVD or AVD for patients with newly diagnosed Hodgkin’s lymphoma: a phase 1, open-label, dose-escalation study. Lancet Oncol 2013; 14 (13): 1348–1356. doi: 10.1016/S1470-2045 (13) 70501-1.

10. Connors JM, Ansell SM, Fanale M et al. Five-year follow-up of brentuximab vedotin combined with ABVD or AVD for advanced-stage classical Hodgkin lymphoma. Blood 2017; 130 (11): 1375–1377. doi: 10.1182/blood-2017-05-784678.

11. Connors JM, Jurczak W, Straus DJ et al. Brentuximab vedotin with chemotherapy for stage III or IV Hodgkin’s lymphoma. N Engl J Med 2018; 378 (4): 331–344. doi: 10.1056/NEJMoa1708984.

12. Suri A, Mould DR, Song G et al. Population pharmacokinetic modeling and exposure-response assessment for the antibody-drug conjugate brentuximab vedotin in Hodgkin’s lymphoma in the phase III ECHELON-1 study. Clin Pharmacol Ther 2019; 106 (6): 1268–1279. doi: 10.1002/cpt.1530.

13. Borchmann P, Fosså A, Długosz-Danecka M et al. The phase 3 study ECHELON-1 evaluating brentuximab vedotin in patients with newly diagnosed Hodgkin lymphoma leaves important questions unanswered. Hemasphere 2018; 2 (3): e52. doi: 10.1097/HS9.0000000000000052.

14. Straus DJ, Dlugosz-Danecka M, Connors JM et al. Brentuximab vedotin with chemotherapy for patients with previously untreated stage III/IV Classical Hodgkin Lymphoma: 5year update of the ECHELON-1 study. Lancet Haematol 2021; 8 (6): e410–e421. doi: 10.1016/S2352-3026 (21) 00102-2.

15. Hutchings M, Radford J, Ansell SM et al. Brentuximab vedotin plus doxorubicin, vinblastine, and dacarbazine in patients with advanced-stage, classical Hodgkin lymphoma: a prespecified subgroup analysis of high-risk patients from the ECHELON-1 study. Hematol Oncol 2021; 39 (2): 185–195. doi: 10.1002/hon.2838.

16. Straus DJ, Dlugosz-Danecka M, Alekseev S et al. Brentuximab vedotin with chemotherapy for stage III/IV classical Hodgkin lymphoma: 3-year update of the ECHELON-1 study. Blood 2020; 135 (10): 735–742. doi: 10.1182/blood.2019003127.

17. Straus DJ, Collins G, Walewski J et al. Primary prophylaxis with G-CSF may improve outcomes in patients with newly diagnosed stage III/IV Hodgkin lymphoma treated with brentuximab vedotin plus chemotherapy. Leuk Lymphoma 2020; 61 (12): 2931–2938. doi: 10.1080/104 28194.2020.1791846.

18. Eichenauer DA, Plütschow A, Kreissl S et al. Incorporation of brentuximab vedotin into first-line treatment of advanced classical Hodgkin’s lymphoma: final analysis of a phase 2 randomised trial by the German Hodgkin Study Group. Lancet Oncol 2017; 18 (12): 1680–1687. doi: 10.1016/S1470-2045 (17) 30696-4.

19. Ramchandren R, Domingo-Domènech E, Rueda A et al. Nivolumab for newly diagnosed advanced-stage classic Hodgkin lymphoma: safety and efficacy in the phase II CheckMate 205 study. J Clin Oncol 2019; 37 (23): 1997–2007. doi: 10.1200/JCO.19.00315.

20. Chen R, Zinzani PL, Fanale MA et al. Phase II study of the efficacy and safety of pembrolizumab for relapsed/refractory classic Hodgkin lymphoma. J Clin Oncol 2017; 35 (19): 2125–2132. doi: 10.1200/JCO.2016.72.1316.

21. Allen PB, Savas H, Evens AM et al. Pembrolizumab followed by AVD in untreated early unfavorable and advanced-stage classical Hodgkin lymphoma. Blood 2021; 137 (10): 1318–1326. doi: 10.1182/blood.2020007400.