Updates in Standard of Care and Disease Management Strategies for Patients With Hodgkin Lymphoma
At the 2025 Lymphoma, Leukemia & Myeloma (LL&M) Winter Symposium in Miami, Florida, Craig Moskowitz, MD, University of Miami Sylvester Comprehensive Cancer Center, Miami, Florida, discusses updates in treatment of Hodgkin lymphoma, including elimination of radiation therapy for early-stage disease, updated standard of care for advanced disease, and elimination of transplantation for patients with relapsed/refractory (R/R) disease.
Transcript:
My name is Craig Moskowitz. I'm the physician in chief of the Oncology Service Line at the University of Miami Sylvester Comprehensive Cancer Center. I'm here today at the LL&M Conference at the Fontainebleau to discuss updates in Hodgkin lymphoma.
My presentation is focused really on 3 different aspects. The first is, can radiation therapy be eliminated in early-stage Hodgkin lymphoma? The second is there a new standard of care for advanced stage disease? And third, can we eliminate transplantation from the management of patients with relapsed and refractory Hodgkin lymphoma?
Just a little brief summary, for patients with early-stage disease, which is more common than advanced stage disease, I have been focusing the use of treatment based upon the RAPID study, which is for patients with stage 1A and 2A disease, non-bulky, without B symptoms. The original publication was in the New England Journal by John Radford.
There has been an update at 15 years showing that there is no difference in overall survival between patients who received 3 months of [doxorubicin, bleomycin, vinblastine, and dacarbazine] (ABVD) versus those who received 3 months of ABVD and radiation therapy. There's somewhat of a caveat to that. In patients with a single nodal mass of at least 5 centimeters, there is a progression-free survival advantage in patients who get radiated after a PET negative response to ABVD versus patients who are monitored.
The son of the rapid study is called the RADAR study, which is an international random assignment trial comparing brentuximab vedotin and ABVD versus ABVD. This is an ongoing clinical trial. I'm the lead investigator in North America. It's nearly a 1000 patient study, which will take a number of years to complete. However, it is the registration trial for brentuximab for early-stage Hodgkin lymphoma.
The second aspect is in the era of novel treatments, is there a new standard therapy for patient with advanced stage Hodgkin lymphoma? For the past 3 or 4 years, brentuximab and ABVD have been standard in the US based upon the ECHELON-1 study. This is now debatable. There are 2 probably better treatments than that.
The first was published by the German Hodgkin Lymphoma study group called [brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine, and dexamethasone] (BrECADD). BrECADD is the son of escalated [bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone] (eBEACOPP). It replaces some of the more toxic treatments in escalated eBEACOPP and incorporates brentuximab, dacarbazine and dexamethasone.
This was designed as a non-inferiority study. However, at 4 years, actually the BrECADD is superior with a 94% progression-free survival. There's some assets with PET negativity, but 65% of the patients only receive 3 months of treatment. It's clearly more toxic than some of the other regimens, but it is given in half the amount of time. It is somewhat agreeable to certain patient populations.
The US Intergroup study compared brentuximab and ABVD to nivolumab and ABVD, and to me it's fairly clear that the nivo-ABVD arm 1, it is 9% better at 2 years, and it is markedly better in the elderly patient population where I believe it is now standard of care. It's also the first US Intergroup study that the Children Oncology Group participated in. They enrolled over 200 patients and in that patient population age 12 to 17, there was also a progression-free survival advantage to the nivo-ABVD arm.
Lastly, in relapsed and refractory disease, standard treatment for 30 years has been salvaged therapy, usually [ifosfamide, carboplatin, and etoposide] (ICE) chemotherapy, which I designed now 31 years ago, followed by transplant. It is very clear that with the use of novel treatments, I particularly am enamored with a program pembrolizumab, gemcitabine, vinorelbine and doxorubicin.
We published in the JCO a couple of years ago that this program followed by transplantation at 5 years has a 90% progression-free survival. When treatments are that good, you're probably overtreating patients. We did another study which used the same backbone for 4 cycles, eliminated transplantation and gave 1 year of maintenance therapy.
The results are somewhat mixed, but about 2 thirds of patients remain progression-free at 2 years. Clearly better in patients with early stage and advanced stage disease, and there are large now randomized phase 2 studies that are building upon that approach. Thanks for your attention.
Source:
Moskowitz C. Updates in Hodgkin Lymphoma. Presented at Lymphoma, Leukemia & Winter Symposium; February 7-9, 2025. Miami, Florida.
