open access

Vol 11, No 4 (2015)
Review paper
Published online: 2015-08-27
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Hodgkin lymphoma — closer to failure-free therapy

Ewa Paszkiewicz-Kozik, Jan Walewski
Oncol Clin Pract 2015;11(4):202-214.

open access

Vol 11, No 4 (2015)
REVIEW ARTICLES
Published online: 2015-08-27

Abstract

A major challenge in the clinical research on Hodgkin lymphoma (HL) is an optimization of the current treatment algorithms in a way that would reduce late toxicity without compromising efficacy. Population based studies evaluating late effects of treatment of HL of limited stage indicate a risk of relapse at 10% to 20%, mostly occurring within the first 3 years post-therapy, and on the other hand, a risk of second malignancy or cardiovascular disease increasing constantly and markedly exceeding the corresponding risk in healthy people. Elevated risk of late complications is attributed to the oncogenic potential of combined modality treatment including both cytotoxic agents and mediastinal irradiation but randomized trials successfully addressing radiation-free and/or alkylator-free regimens that could change a paradigm of combined chemo- and radiotherapy have not been performed. In this review, we present in brief guideline-based treatment outcomes, new data from the recent studies related to the risk-adapted therapy guided by the early response assessment with interim positron emission tomography/computed tomography, studies on recurrent disease as well as novel agents. It is hoped that recent advances in the field of immunotherapy including toxin conjugated anti-CD30 antibody and checkpoint inhibitor anti-PD1 antibody will drive a progress in the systemic treatment of HL as it already happened in some solid tumors.

Abstract

A major challenge in the clinical research on Hodgkin lymphoma (HL) is an optimization of the current treatment algorithms in a way that would reduce late toxicity without compromising efficacy. Population based studies evaluating late effects of treatment of HL of limited stage indicate a risk of relapse at 10% to 20%, mostly occurring within the first 3 years post-therapy, and on the other hand, a risk of second malignancy or cardiovascular disease increasing constantly and markedly exceeding the corresponding risk in healthy people. Elevated risk of late complications is attributed to the oncogenic potential of combined modality treatment including both cytotoxic agents and mediastinal irradiation but randomized trials successfully addressing radiation-free and/or alkylator-free regimens that could change a paradigm of combined chemo- and radiotherapy have not been performed. In this review, we present in brief guideline-based treatment outcomes, new data from the recent studies related to the risk-adapted therapy guided by the early response assessment with interim positron emission tomography/computed tomography, studies on recurrent disease as well as novel agents. It is hoped that recent advances in the field of immunotherapy including toxin conjugated anti-CD30 antibody and checkpoint inhibitor anti-PD1 antibody will drive a progress in the systemic treatment of HL as it already happened in some solid tumors.

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Keywords

Hodgkin lymphoma, ESMO recommendations, combined modality treatment, risk adapted therapy, PET, brentuximab vedotin, nivolumab, panobinostat, CD30, PD1, HDACi

About this article
Title

Hodgkin lymphoma — closer to failure-free therapy

Journal

Oncology in Clinical Practice

Issue

Vol 11, No 4 (2015)

Article type

Review paper

Pages

202-214

Published online

2015-08-27

Bibliographic record

Oncol Clin Pract 2015;11(4):202-214.

Keywords

Hodgkin lymphoma
ESMO recommendations
combined modality treatment
risk adapted therapy
PET
brentuximab vedotin
nivolumab
panobinostat
CD30
PD1
HDACi

Authors

Ewa Paszkiewicz-Kozik
Jan Walewski

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