Treatments for advanced Hodgkin lymphoma

Advanced Hodgkin lymphoma (HL) includes stages 3 and 4. Some treatment centres will also consider stage 2B or stage 2 bulky disease to be advanced stage disease. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

The standard treatment for advanced HL is chemoimmunotherapy. It is sometimes followed by radiation therapy.

Chemoimmunotherapy combines chemotherapy with an immunotherapy drug. Chemotherapy uses drugs to destroy cancer cells. Immunotherapy helps strengthen or restore the immune system’s ability to find and destroy cancer cells.

The types of immunotherapy drugs used with HL are antibody drug conjugates (ADCs) and immune checkpoint inhibitors. These are combined with standard chemotherapy drugs that have been used for HL.

The following are the most common chemoimmunotherapy combinations used to treat advanced HL:

• BV-AV – brentuximab vedotin (Adcetris), doxorubicin, bleomycin, vinblastine and dacarbazine
• BR-CADD – brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine and dexamethasone
• Nivo-AVD – nivolumab (Opdivo), doxorubicin, vinblastine and dacarbazine

Chemoimmunotherapy is usually given for 6 cycles over about 6 months.

During chemoimmunotherapy your healthcare team will use PET or CT scans to monitor how well the treatment is working.

If, during your treatment, scans show that the cancer is not responding or is progressing, it is considered to be refractory disease. Your healthcare team will treat you for refractory disease.

If, after the chemoimmunotherapy cycles have finished, scans show that the cancer has responded but the PET scan is still positive for HL, your healthcare team may recommend radiation therapy.

Find out more about chemoimmunotherapy therapy for Hodgkin lymphoma.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. External radiation therapy is used for HL. A machine directs radiation through the skin to the tumour and some of the tissue around it. External radiation therapy is also called external beam radiation therapy.

External radiation therapy is used for advanced HL that has not completely responded to chemoimmunotherapy. A machine directs radiation through the skin to the tumour and some of the tissue around it. External radiation therapy is also called external beam radiation therapy.

Doctors give radiation to the smallest area possible to help lower the risk of side effects. They will use different techniques to accurately target the area to be treated and spare as much surrounding normal tissue as possible. For advanced HL, they will give radiation to the areas that still have cancer after chemoimmunotherapy as well as to some of the nearby tissue.

Find out more about radiation therapy for Hodgkin lymphoma.

Talk to your doctor about clinical trials open to people with HL in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.