Immunotherapy in Hodgkin lymphoma

Current and evolving roles

Abstract

Classical Hodgkin lymphoma (cHL) is a very curable form of cancer for the majority of patients that receive standard primary therapy. Many patients will have a second opportunity for cure at the time of first progression using approaches that incorporate high dose chemotherapy and autologous stem cell transplant (ASCT). In the non-curative setting, a group of patients (including patients with advanced age and comorbidities precluding standard therapy approaches and those with lymphoma that persists despite these treatments) will be treated with palliative intent. While these patients have had limited options in the past, novel therapies have rapidly become the standard of care in this setting. Antibodies targeting CD30 (the antibody drug conjugate brentuximab vedotin [BV]) and the immune checkpoint through PD1 (nivolumab and pembrolizumab) have now become standard approved treatments for patients beyond second-line treatment. The biology of PD1 appears particularly relevant in cHL, providing a strong clinical rationale for evaluating these agents in this malignancy. Clinicians in Canada now have several choices when making treatment decisions in patients with relapsed or refractory cHL (RR-cHL). Prospective trials are now determining the role of anti-PD1 antibodies in the curative setting.