Hodgkin lymphoma is divided into two main types; classical Hodgkin lymphoma accounts for approximately 95% of the cases in the United States, while nodular lymphocyte predominant Hodgkin lymphoma represents the remaining cases. The immunotherapeutic agents discussed in this section are approved for the treatment of classical Hodgkin lymphoma only.
Approved immunotherapeutic agents
Combination therapy/treatment algorithms
Approved immunotherapeutic agents (for classical hodgkin lymphoma)
Brentuximab vedotin (Adcetris, Seattle Genetics) is an antibody-drug conjugate; it combines an anti-CD30 monoclonal antibody with a chemotherapy drug to directly target classical Hodgkin lymphoma cells, which express CD30 on their surfaces (Figure 3). The drug was approved in 2011 for the treatment of patients with classical Hodgkin lymphoma who have failed high-dose chemotherapy with autologous stem cell rescue (HDT/ASCR) or have failed at least two prior chemotherapy regimens.
Figure 3. Brentuximab vedotin mechanism of action.
In 2016, the anti–PD-1 checkpoint inhibitor nivolumab was approved for the treatment of classical Hodgkin lymphoma in patients who have relapsed or progressed following HDT/ASCR and treatment with brentuximab vedotin.
Classical hodgkin lymphoma combination therapy/treatment algorithms
Currently, neither brentuximab vedotin or nivolumab are recommended in combination with any other treatment agents.
Current clinical trials for classical hodgkin lymphoma
Phase 1/2 trials are underway evaluating nivolumab for the treatment of previously treated or newly diagnosed Hodgkin lymphoma, and nivolumab in combination with brentuximab vedotin for the treatment of older patients with previously untreated Hodgkin lymphoma and patients with relapsed or refractory Hodgkin lymphoma. Both ipilimumab and pembrolizumab are being investigated in combination with brentuximab vedotin for the treatment of relapsed or refractory Hodgkin lymphoma. The investigative PD-L1 inhibitor avelumab is also currently in clinical trials, as are multiple CAR therapies targeting CD19.
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