Treatment Strategies in Advanced-Stage Hodgkin Lymphoma.

Simple Summary: The treatment of advanced-stage Hodgkin lymphoma (HL) is a rapidly evolving field with the introduction of new antibody-mediated drugs to first-line therapies and improving progression-free survival (PFS) to 80–94%. The novel modalities include the anti-CD30 antibody drug conjugate brentuximab vedotin and the anti-PD1 antibody (immune checkpoint inhibitor) that blocks a receptor, helping HL cells to turn off the immune cells, fighting malignant cells. When aggressive therapy is used, a negative result of the interim PET/CT scan can be predictive of a favorable outcome, allowing for a subsequent de-escalation of therapy. A more aggressive therapy is associated with higher short-term and long-term toxicity. Thus, the treatment choice for young patients (median age 30–34 years) should also take into consideration the long-term toxicity, since their expected life longevity exceeds half a century. The current review analyzes the recently published studies that may become practice changing and lead to significantly improved PFS. The last 3 decades have witnessed a major evolution in the treatment of advanced-stage Hodgkin lymphoma (HL). The most prominent of these developments include the introduction of the international prognostic scoring (IPS) system; therapeutic decision-making based on both IPS and interim PET/CT data; the finding that a negative interim PET/CT result could be safely used for treatment de-escalation; the introduction of intensive combination chemotherapy like escalated BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, oncovin (vincristine), procarbazine, and prednisone); and further modification of this protocol with the incorporation of a conjugated anti-CD30 antibody brentuximab vedotin (BV) into first-line regimens, like BV-AVD (BV+ adriamycin, vinblastine and dacarbazine) and BrECADD (brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine, and dexamethasone). The accruing data about the toxicity of the escalated BEACOPP protocol have led to decreasing the number of therapeutic cycles, substitution of toxic agents like procarbazine with dacarbazine (e.g., BEACOPDac), and reduction/omission of radiation therapy. Lately, a significant advancement has been made by the integration of checkpoint inhibitors in the first-line treatment, with preliminary results demonstrating the superiority of anti-PD1 combined with chemotherapy (nivolumab-AVD) compared to the BV-AVD regimen. This review aims to analyze recently published studies whose findings could change the treatment practice in advanced-stage HL. [ABSTRACT FROM AUTHOR]