This E-Learning module elaborates the treatment of patients with newly diagnosed classical Hodgkin lymphoma from the aspects of staging and upfront risk allocation, standard of care and open questions in early and advanced stages of the disease; moreover, it provides an overview of evolving therapies.
The author states that, in the management of early stage Hodgkin lymphoma, progression-free survival does not necessarily translate into overall survival. In principle, failing of low-intensity treatment leaves a chance for the second treatment. In early stage favourable disease, PET-guided omission of radiotherapy missed the proof of non-inferiority in large clinical trials, thus chemotherapy remains standard of care. However, in early stage unfavourable disease, PET guided therapy can improve the treatment. Clinical trials have shown that PET allows to identify poor-responders and to improve their outcome by the intensification of treatment, if patients have been treated upfront with a low intensity regimen. Furthermore, PET-guided strategy allows omission of consolidation radiotherapy without loss of tumour control, if systemic treatment included upfront intensive chemotherapy.
Different options are available for the treatment of advanced stage Hodgkin lymphoma; however, with rather large differences regarding the primary cure rate favouring a more intensive upfront treatment strategy. Therefore, the healthcare infrastructure and individual preferences should be taken into consideration for shared decision making on primary treatment. Age is an important factor and needs to be taken into account.
The author further emphasises that in advanced stage Hodgkin lymphoma, progression-free survival differences translate into overall survival differences. Progression-free survival and thus primary cure reflects the primary treatment goal. In the module, the author describes the results from different clinical trials that assessed the treatment escalation for high-risk patients, the effects on the toxicity profile, guided de-escalation, studying novel agents, such as brentuximab vedotin or nivolumab, the combination with chemotherapy and illustrates the outcomes in terms of efficacy and safety.
The author concludes that besides lymphoma control, which is overall very good with all the different therapies, future developments should include patients’ reported outcomes and should focus on supporting the patients to get back into normal life.
