Abstract
Hodgkin lymphoma (HL) is a lymphoid malignancy of germinal center B cell origin. Conventional chemotherapy with or without radiation induces high cure rates but these treatments can have relevant long-term toxic side effects. As a result, there remains a lot of debate about the optimal management of these patients, especially for limited-stage disease. The last two decades have resulted in a greater understanding of the underlying biology of HL, including the presence of an aberrant phenotype on the tumor cells and the necessity of immune escape. Based on these insights, novel therapeutic approaches have been introduced, including the CD30-directed antibody drug conjugate brentuximab vedotin (BV) and the immune checkpoint inhibitors (ICI), nivolumab and pembrolizumab. After demonstrating to be effective and well tolerated in patients with relapsed/refractory (R/R) disease, these agents are currently being investigated as part of front-line regimens in clinical trials for both limited and advanced stage HL. Results are encouraging and the expectation is that these immunotherapies will be incorporated for the treatment of all stages of the disease. Not only is the hope these agents will further improve outcomes, but it will also reduce our dependence on chemotherapy and radiation in these settings, thereby mitigating the risk of long-term toxicity. This review will provide an overview of the molecular biology of HL, discuss the current standard of care for all stages of the disease, and highlight how immunotherapies are changing the current treatment landscape.
Keywords
Hodgkin Lymphoma, Brentuximab vedotin, Immune checkpoint inhibitor, Nivolumab, Frontline