Nivolumab plus AVD chemotherapy for patients with advanced classical Hodgkin lymphoma

This study assessed the effectiveness of nivolumab (Opdivo) alone or with chemotherapy for patients with advanced classical Hodgkin lymphoma (cHL). This study concluded that nivolumab plus chemotherapy was promising, with manageable side effects for these patients.

Standard first-line chemotherapy is highly effective in treating 70 – 80% of patients with cHL. Unfortunately, this treatment is not as effective for patients with advanced-stage disease. 5 years after initial treatment, the cancer comes back in 20 – 30% of patients with advanced cHL.

Previous studies have shown that PD-1 inhibitors such as nivolumab (Opdivo) are effective for recurrent cHL. PD-1 inhibitors bind to cancer cells, marking them as targets for the body’s immune system. This leads to cancer cell death. This treatment is commonly used alone, as a monotherapy. Whether it is more effective when combined with chemotherapy for patients with advanced cHL is unclear.

This study involved 51 patients with advanced cHL that was not treated before. This study had two phases. First, patients received 4 doses of nivolumab monotherapy. Then, patients received combination therapy: 12 doses of N-AVD (nivolumab plus doxorubicin, vinblastine, and dacarbazine). Patients were followed-up for an average of 11.1 months.

Overall, 69% of patients responded to monotherapy treatment. 18% of patients had a complete disappearance of all signs of cancer. After the second phase, 84% of all patients responded to combination therapy. 80% of patients had a complete disappearance of all signs of cancer. 6% of patients had tumor growth or spread.

At follow-up, 98% of patients were still alive. 92% of patients were still alive without tumor growth or spread. 

Overall, 96% of all patients reported side effects. Most of these were mild. The most common ones were infusion-related reactions (29%) and skin rash (5.9%). 59% of patients reported severe side effects. The most common was severely low white blood cell count with (10%) and without fever (49%). Severe infections also occurred in 4% of patients.

This study concluded that nivolumab plus chemotherapy was promising, with manageable side effects for patients with advanced cHL.

This was a small study. More studies with a larger patient population and a longer follow-up are needed to confirm these results.