Recent treatment advances in Hodgkin lymphoma: a concise review

Abstract

The majority of patients with Hodgkin Lymphoma enjoy durable remissions following front-line treatment. This typically involves combination chemotherapy with or without radiotherapy. A significant minority of patients experience relapsed/refractory disease, of whom only approximately half can be 'salvaged' with conventional second-line treatments. Until recently, for those patients either failing or who are not fit for salvage, there have been few curative alternatives. Furthermore, there is a significant risk of delayed treatment complications to conventional therapies, including secondary malignancies and cardiac disease. However, novel targeted therapies are producing excellent results in clinical trials. They provide additional treatment options for those with relapsing/refractory disease; they may also have potential in front-line therapy. The anti-CD30 antibody brentuximab vedotin has been tested as monotherapy and in combination in a variety of clinical settings, including in relapsed/refractory patients and as consolidative therapy following standard second-line therapy. Nivolumab and Pembrolizumab, currently used in other malignancies that are also known to utilise the programmed death pathway for survival, have shown outstanding results when used as single agents in heavily pre-treated (including brentuximab vedotin refractory) patients. Individualising and adapting a patient's treatment course, whether augmenting or rationalising therapy, based on an interim PET/CT response is an important strategy currently under exploration to minimise toxicity while maximising response. Further work is needed to explore clinical and biological factors associated with improved outcomes. Knowledge of these factors combined with the movement of novel therapies into the front-line setting will enable individualised therapy to enhance clinical responses and minimize toxicities.

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

“…Gains in SDI are likely to operate through many pathways, including improved access to health care, public health programmes, and social and welfare policy. Advances in treatment are well documented for various causes, including HIV/AIDS, 30 , 31 , 32 ischaemic heart disease, 33 , 34 , 35 , 36 , 37 and various cancers, 38 , 39 , 40 including breast, 41 , 42 , 43 testicular, 44 and Hodgkin's, 45 yet for other causes, such as oesophageal cancer and interpersonal violence, the policies, programmes, and interventions responsible for declining risk-deleted death and DALY rates are less clear than for the aforementioned causes. Improvement of understanding of the risk-deleted rates in cause-specific mortality and disease burden will strengthen the evidence base for intervention effectiveness, the role of medical care access in addressing disease burden, and the importance of other social and welfare policies.…”

Long‐term survival among 5‐year survivors of adolescent and young adult cancer

“…Among the differences in these patients' survival rates by decade of diagnosis, differences in the 10-year survival rates were most pronounced, suggesting that the long-term improvements in survival likely were due to improvements in treating the primary disease and preventing or delaying disease progression and recurrence. [29][30][31][32][33] In contrast, among AYA survivors of melanoma, the long-term survival rates of those diagnosed in the 1970s, 1980s, or 1990s did not differ significantly, whereas those survivors diagnosed in the 2000s had improved early survival. It is important to note that, compared with those diagnosed in earlier decades, survivors of melanoma who were diagnosed in the 2000s had a higher rate of localized disease at the time of presentation, potentially skewing outcomes, because the current study data demonstrated that survivors who presented with local melanoma had significantly better survival than those who presented with regional or metastatic disease (see Supporting Fig.…”

Urgent need to define Pretreatment predictors of immune check point inhibitors related endocrinopathies: A case report and review of literature

“…[16][17][18][19][20] It is also showing promise in the treatment of Hodgkin's lymphoma. [21] With their outstanding efficacy in many cancers, their use is likely to increase in clinical practice. They are effective in younger as well as older age groups.…”