The treatment landscape for advanced-stage classic Hodgkin’s lymphoma (cHL) is rapidly evolving. Traditionally, chemotherapy regimens such as AVD (doxorubicin, vinblastine, dacarbazine) or combinations including brentuximab vedotin have been used to manage this challenging disease. However, a groundbreaking phase 3 clinical trial (S1826) has introduced a promising new regimen—nivolumab (N+AVD)—that is proving to be superior in terms of both efficacy and safety compared to existing treatments.
The Promise of Nivolumab in Combination Therapy
Nivolumab, a PD-1 inhibitor, has shown tremendous potential by harnessing the immune system to target cancer cells more effectively. When combined with the AVD chemotherapy backbone, nivolumab offers improved outcomes for patients with stage III or IV Hodgkin’s lymphoma. The S1826 trial compared the nivolumab combination to brentuximab vedotin plus AVD (BV+AVD) and found the following results:
- Superior Progression-Free Survival (PFS): The study demonstrated that patients receiving N+AVD had a 2-year PFS of 92%, compared to 83% for BV+AVD. This significant difference marks an important advancement in disease control for these patients.
- Better Tolerability: Nivolumab combined with AVD also had a more favorable side-effect profile. Patients experienced fewer high-grade toxicities, and importantly, the combination led to lower rates of treatment discontinuation due to adverse events compared to BV+AVD.
What Makes Nivolumab Special?
One of the main advantages of nivolumab is its ability to block the PD-1 pathway, which is overexpressed in Hodgkin’s lymphoma cells. This blockade helps the immune system better recognize and attack cancer cells. This novel mechanism, combined with chemotherapy, offers a more targeted and durable approach to treatment.
Additionally, unlike the BV+AVD regimen, which often leads to significant peripheral neuropathy and requires more supportive care such as granulocyte colony-stimulating factor (G-CSF) for neutropenia, nivolumab offers a safer alternative with less need for supportive interventions.
Changing the Standard of Care for Hodgkin’s lymphoma
The S1826 trial results show promise for advancing treatment in advanced-stage Hodgkin’s lymphoma, though it won’t yet change the standard of care. While the N+AVD combination improves progression-free survival and minimizes side effects, final long-term survival data is still needed. With more data, this approach may eventually become the preferred first-line therapy for adolescents and adults, signaling progress in the right direction.
Looking Forward
As research continues, the role of immunotherapy in lymphoma treatment is expected to grow. For patients and families, this new regimen provides hope for better outcomes with fewer complications. Clinicians now have a new tool in the fight against this aggressive disease, one that balances effectiveness with quality of life—a critical aspect in the treatment of cancer patients.
About the author
Dr. Daniel Landau is a distinguished board-certified hematologist/oncologist renowned for his exceptional contributions in the field. With an illustrious career spanning across esteemed institutions like the Orlando Health Cancer Institute and the Medical University of South Carolina, Dr. Landau’s expertise shines in both genitourinary oncology and hematology. .
Engage with Dr. Landau’s expertise and ignite your curiosity on “Ask MedOnCMD” as he invites you to explore the vast landscape of oncology with a fresh outlook.