Optimizing frontline therapy for classical Hodgkin lymphoma: A mini-review of PET-directed chemotherapy, brentuximab-based regimens, and checkpoint inhibitor combinations

Abstract

Classical Hodgkin lymphoma is a highly curable malignancy, but long-term treatment-related toxicities remain a challenge, especially in young survivors. In recent years, treatment has shifted from traditional doxorubicin, bleomycin, vinblastine, and dacarbazine regimens to novel approaches such as positron emission tomography-guided therapy, brentuximab vedotin-doxorubicin, vinblastine, dacarbazine (AVD), and checkpoint inhibitor combinations such as nivolumab (Nivo)-AVD. This review evaluates these three frontline strategies in terms of efficacy, toxicity, and their potential to personalize treatment and minimize late complications. Drawing from trials such as ECHELON-1, NIVAHL, SWOG S1826, and BREACH, we analyze current evidence, evaluate conflicting data, and propose considerations for tailoring therapy to patient subgroups.

Keywords

Hodgkin lymphoma / ABVD / Brentuximab vedotin / Nivolumab / PET-adapted therapy / Immunotherapy / Frontline treatment / Toxicity