Immunotherapy in Hodgkin Lymphoma: Present Status and Future Strategies
Although classical Hodgkin lymphoma (cHL) is usually curable, 20−30% of the patients experience treatment failure and most of them are typically treated with salvage chemotherapy and autologous stem cell transplantation (autoSCT). However, 45−55% of that subset further relapse or...
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doaj-3aa975caafe7461ab45011d597e15bc62020-11-25T02:16:41ZengMDPI AGCancers2072-66942019-07-01118107110.3390/cancers11081071cancers11081071Immunotherapy in Hodgkin Lymphoma: Present Status and Future StrategiesTheodoros P. Vassilakopoulos0Chrysovalantou Chatzidimitriou1John V. Asimakopoulos2Maria Arapaki3Evangelos Tzoras4Maria K. Angelopoulou5Kostas Konstantopoulos6Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, GreeceDepartment of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, GreeceDepartment of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, GreeceDepartment of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, GreeceDepartment of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, GreeceDepartment of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, GreeceDepartment of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, GreeceAlthough classical Hodgkin lymphoma (cHL) is usually curable, 20−30% of the patients experience treatment failure and most of them are typically treated with salvage chemotherapy and autologous stem cell transplantation (autoSCT). However, 45−55% of that subset further relapse or progress despite intensive treatment. At the advanced stage of the disease course, recently developed immunotherapeutic approaches have provided very promising results with prolonged remissions or disease stabilization in many patients. Brentuximab vedotin (BV) has been approved for patients with relapsed/refractory cHL (rr-cHL) who have failed autoSCT, as a consolidation after autoSCT in high-risk patients, as well as for patients who are ineligible for autoSCT or multiagent chemotherapy who have failed ≥ two treatment lines. However, except of the consolidation setting, 90−95% of the patients will progress and require further treatment. In this clinical setting, immune checkpoint inhibitors (CPIs) have produced impressive results. Both nivolumab and pembrolizumab have been approved for rr-cHL after autoSCT and BV failure, while pembrolizumab has also been licensed for transplant ineligible patients after BV failure. Other CPIs, sintilimab and tislelizumab, have been successfully tested in China, albeit in less heavily pretreated populations. Recent data suggest that the efficacy of CPIs may be augmented by hypomethylating agents, such as decitabine. As a result of their success in heavily pretreated disease, BV and CPIs are moving to earlier lines of treatment. BV was recently licensed by the FDA for the first-line treatment of stage III/IV Hodgkin lymphoma (HL) in combination with AVD (only stage IV according to the European Medicines Agency (EMA)). CPIs are currently being evaluated in combination with AVD in phase II trials of first-line treatment. The impact of BV and CPIs was also investigated in the setting of second-line salvage therapy. Finally, combinations of targeted therapies are under evaluation. Based on these exciting results, it appears reasonable to predict that an improvement in survival and a potential increase in the cure rates of cHL will soon become evident.https://www.mdpi.com/2072-6694/11/8/1071Hodgkin lymphomabrentuximab vedotinnivolumabpembrolizumabrelapsedrefractory |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Theodoros P. Vassilakopoulos Chrysovalantou Chatzidimitriou John V. Asimakopoulos Maria Arapaki Evangelos Tzoras Maria K. Angelopoulou Kostas Konstantopoulos |
spellingShingle |
Theodoros P. Vassilakopoulos Chrysovalantou Chatzidimitriou John V. Asimakopoulos Maria Arapaki Evangelos Tzoras Maria K. Angelopoulou Kostas Konstantopoulos Immunotherapy in Hodgkin Lymphoma: Present Status and Future Strategies Cancers Hodgkin lymphoma brentuximab vedotin nivolumab pembrolizumab relapsed refractory |
author_facet |
Theodoros P. Vassilakopoulos Chrysovalantou Chatzidimitriou John V. Asimakopoulos Maria Arapaki Evangelos Tzoras Maria K. Angelopoulou Kostas Konstantopoulos |
author_sort |
Theodoros P. Vassilakopoulos |
title |
Immunotherapy in Hodgkin Lymphoma: Present Status and Future Strategies |
title_short |
Immunotherapy in Hodgkin Lymphoma: Present Status and Future Strategies |
title_full |
Immunotherapy in Hodgkin Lymphoma: Present Status and Future Strategies |
title_fullStr |
Immunotherapy in Hodgkin Lymphoma: Present Status and Future Strategies |
title_full_unstemmed |
Immunotherapy in Hodgkin Lymphoma: Present Status and Future Strategies |
title_sort |
immunotherapy in hodgkin lymphoma: present status and future strategies |
publisher |
MDPI AG |
series |
Cancers |
issn |
2072-6694 |
publishDate |
2019-07-01 |
description |
Although classical Hodgkin lymphoma (cHL) is usually curable, 20−30% of the patients experience treatment failure and most of them are typically treated with salvage chemotherapy and autologous stem cell transplantation (autoSCT). However, 45−55% of that subset further relapse or progress despite intensive treatment. At the advanced stage of the disease course, recently developed immunotherapeutic approaches have provided very promising results with prolonged remissions or disease stabilization in many patients. Brentuximab vedotin (BV) has been approved for patients with relapsed/refractory cHL (rr-cHL) who have failed autoSCT, as a consolidation after autoSCT in high-risk patients, as well as for patients who are ineligible for autoSCT or multiagent chemotherapy who have failed ≥ two treatment lines. However, except of the consolidation setting, 90−95% of the patients will progress and require further treatment. In this clinical setting, immune checkpoint inhibitors (CPIs) have produced impressive results. Both nivolumab and pembrolizumab have been approved for rr-cHL after autoSCT and BV failure, while pembrolizumab has also been licensed for transplant ineligible patients after BV failure. Other CPIs, sintilimab and tislelizumab, have been successfully tested in China, albeit in less heavily pretreated populations. Recent data suggest that the efficacy of CPIs may be augmented by hypomethylating agents, such as decitabine. As a result of their success in heavily pretreated disease, BV and CPIs are moving to earlier lines of treatment. BV was recently licensed by the FDA for the first-line treatment of stage III/IV Hodgkin lymphoma (HL) in combination with AVD (only stage IV according to the European Medicines Agency (EMA)). CPIs are currently being evaluated in combination with AVD in phase II trials of first-line treatment. The impact of BV and CPIs was also investigated in the setting of second-line salvage therapy. Finally, combinations of targeted therapies are under evaluation. Based on these exciting results, it appears reasonable to predict that an improvement in survival and a potential increase in the cure rates of cHL will soon become evident. |
topic |
Hodgkin lymphoma brentuximab vedotin nivolumab pembrolizumab relapsed refractory |
url |
https://www.mdpi.com/2072-6694/11/8/1071 |
work_keys_str_mv |
AT theodorospvassilakopoulos immunotherapyinhodgkinlymphomapresentstatusandfuturestrategies AT chrysovalantouchatzidimitriou immunotherapyinhodgkinlymphomapresentstatusandfuturestrategies AT johnvasimakopoulos immunotherapyinhodgkinlymphomapresentstatusandfuturestrategies AT mariaarapaki immunotherapyinhodgkinlymphomapresentstatusandfuturestrategies AT evangelostzoras immunotherapyinhodgkinlymphomapresentstatusandfuturestrategies AT mariakangelopoulou immunotherapyinhodgkinlymphomapresentstatusandfuturestrategies AT kostaskonstantopoulos immunotherapyinhodgkinlymphomapresentstatusandfuturestrategies |
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