First-line treatment options for patients with Hodgkin’s lymphoma

This article reviewed different options for first-line treatment for Hodgkin lymphoma (HL).

Treatment for patients with HL has become more individualized. Treatment strategies have been adapted to disease risk, and how well patients respond to initial treatment. The goal of these approaches is to reduce side effects without losing effectiveness. For patients older than age 60, the most effective treatments remain under investigation.

For patients with advanced-stage HL, chemotherapy is the typical first-line treatment. ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) is the most common regimen, although BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisolone) is also used. However, BEACOPP is a more intense regimen, with side effects that can cause health complications later. Changing the number of cycles of chemotherapy depending on how patients respond to treatment can help avoid these issues. Radiotherapy may also be recommended.

Predicting treatment outcomes and adjusting treatment intensity as therapy progresses is important. FDG-PET scanning has become an important tool for this. This technique can detect cancer cells during treatment. Scanning done during treatment is called interim PET (iPET). It can also help predict relapse (cancer recurrence).

For patients with early-stage HL, chemotherapy is also a typical first-line treatment. Then, iPET is recommended to see how well the patient responded to initial treatment. If cancer cells are still present, additional chemotherapy may be recommended. For patients who do not respond to treatment, a stem cell transplant or targeted therapy may be recommended.

Brentuximab vedotin (Adcetris) is a monoclonal antibody. This type of targeted therapy binds to cancer cells and blocks their growth. This leads to cancer cell death. Brentuximab vedotin has been commonly used in combination with chemotherapy regimens. In the A+AVD regimen, brentuximab vedotin replaces bleomycin in the ABVD regimen. This regimen may also be recommended for older patients who cannot tolerate more intense therapy.

This article reviewed different first-line treatment options for patients with HL. These included chemotherapy and targeted therapy.