Over the past decades, cure rates for Hodgkin’s lymphoma have consistently improved following advances in chemotherapy and radiotherapy, the use of response-adapted treatment and the incorporation of novel agents into treatment. Then again, chemotherapy and radiation, whilst highly effective, may result in significant long-term toxicity with patients being at an increased risk of secondary malignancies, cardiopulmonary long-term complications, lower fertility rates and impaired quality of life.
This short review focuses on two large, potentially practice-changing randomized trials published in 2023: the German Hodgkin Study Group (GHSG) HD21 trial and the SWOG Cancer Research Network Group S1826 study.
In the HD21 trial the new Brentuximab Vedotin, Etoposide, Cyclophosphamide, Doxorubicine, Dacarbazine, Dexamethsone (BrECADD) regimen has shown (at least) a non-inferiority compared to escalated Bleomycin, Etoposide, Doxorubicin, Cyclophosphamide, Vincristine, Procarbazine, Prednisolone (BEACOPP), the previous standard of care (SOC) for younger (< 60 years), fit Hodgkinʼs lymphoma patients. Due to better hematological tolerability, higher cumulative doses of chemotherapy can be delivered with the BrECADD regimen. Fertility rates after BrECADD seem to be similar to those of the normal population.
The randomized SWOG S1826 trial compared a potential standard of care in the treatment of advanced stage Hodgkinʼs lymphoma, 6 cycles of brentuximab-vedotin AVD (BV-AVD [Adriamycine, Vinblastine, Dexamethasone]), with experimental 6 cycles of nivolumab-AVD (Nivo-AVD). The Nivo-AVD improved PFS and was better tolerated with advantages in treatment-related morbidity and mortality being particularly pronounced in the older (> 60 years) subgroup.
