ASH 2024 | Unmet needs in Hodgkin lymphoma: treating early-stage and relapsed/refractory disease

We’ve done really well in improving outcomes in advanced stage classic Hodgkin lymphoma, now with nivolumab plus ABVD chemotherapy becoming a standard regimen based on the S1826 regimen. We also have the BrECADD regimen from Europe, which is highly effective, though somewhat toxic, but appropriate for a significant number of patients. I think in the early stage patients, there’s still an unmet need in terms of optimizing therapy. So we want to maximize efficacy and minimize toxicity, particularly in this patient population that is enriched with young adults, adolescent and young adult patients. So anything we do now can have significant outcomes for years down the line. So particularly avoiding radiotherapy is a big issue. We don’t have a lot of randomized trials to really identify who needs what degree of treatment. Our chemotherapy works really well, but anthracyclines can have cardiac toxicity. And it’s really a matter of trying to personalize the therapy for the individual patient. And we’ve seen a lot of PET-directed trials that are moving in that direction. But hopefully in the future with circulating tumor DNA and other maybe novel imaging techniques, we’ll be able to better even fine-tune this. One other area I would also mention is in the very refractory patients. With the advent of PD-1 inhibitors being used in second line, patients who are eligible to undergo autologous stem cell transplant are now having really outstanding outcomes with the majority of patients being long-term disease-free. Those patients, however, who relapse after autologous transplant, we try to get them to allogeneic transplant. Sometimes that is difficult. We don’t have a lot of novel new agents, brentuximab and the PD-1 inhibitors aside. CAR T-cell therapy hasn’t really worked. There have been some attempts to try bispecific antibodies and other approaches that have worked in NHL that really haven’t played out yet. So we do have this small but important population of patients with refractory disease for whom we need better options.

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