Treatment approaches for patients with advanced Hodgkin’s lymphoma

This article reviewed different treatment approaches for patients with advanced Hodgkin's lymphoma (HL).

HL is a type of blood cancer of the lymphatic system. HL can be classified in different ways. In limited HL, cancer is found in one or two sites in the lymphatic system. In advanced HL, cancer is found on both sides of the body or in other organs. Patients with limited or advanced HL are treated differently. 

After initial treatment, some patients have cancer come back (relapse) while others stop responding to treatment (refractory). Treatment can be challenging for these patients. Alternative treatment options are needed.

There are three main approaches to treating patients with advanced HL. The first option is ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy. ABVD is effective for most patients. The second option is BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone). While BEACOPP increases the length of time before cancer worsens, it is associated with serious side effects. The third option is brentuximab vedotin (Adcetris; BV) plus AVD (doxorubicin, vinblastine, dacarbazine).

One approach that is growing in use for patients with advanced HL is PET scanning during treatment to assess how well treatment is working. For patients who are responding well, treatment dose can be decreased to reduce the number of side effects. For patients who are responding poorly, treatment can be changed to something else to induce a response. Studies have shown that patients that switched from ABVD to BEACOPP had survival rates of over 90%. Overall, PET scanning allows treatment personalization for patients, although this may increase the cost of treatment.

BV is a biological drug that has improved the success of treatment for patients with recurrent or non-responding HL. BV is usually given to patients who have relapsed after having a stem cell transplant. For patients with advanced HL, BV is also combined with AVD. Studies have shown that BV increases the time without cancer worsening by 5%. However, it can cause serious side effects in patients, including low white blood cells and numbness. It should also be noted that it is expensive.

Nivolumab (Opdivo) and pembrolizumab (Keytruda) are biological drugs for treating relapsed HL. These drugs have shown promise in improving the effectiveness of chemotherapy while not causing serious side effects in patients. 

This article reviewed different treatment approaches for patients with advanced HL. Biological therapies may help make other treatments such as chemotherapy more effective.

This article reviewed selected approaches and would have benefitted from examining a larger range of upcoming treatments.