Chemoimmunotherapy for Hodgkin lymphoma

Chemoimmunotherapy combines chemotherapy drugs with immunotherapy drugs such as antibody-drug conjugates (ADCs) and immune checkpoint inhibitors. The chemotherapy drugs work by destroying cancer cells, while the immunotherapy drugs work by stimulating the body's immune system against cancer cells. Chemoimmunotherapy is a systemic therapy. This means that the drugs travel through the blood to reach and destroy cancer cells all over the body.

If you have chemoimmunotherapy, your healthcare team will use what they know about the cancer and about your health to plan the drugs, doses and schedules. Chemoimmunotherapy is used to treat advanced Hodgkin lymphoma (HL).

The chemoimmunotherapy combinations used for HL include:

• BrAVD– the ADC drug bremtuximab vedotin (Adcetris) and the chemotherapy drugs doxorubicin, vinblastine and dacarbazine
• Nivo-AVD– the immune checkpoint inhibitor drug nivolumab (Opdivo) and the chemotherapy drugs doxorubicin, vinblastine and dacarbazine

Antibody-drug conjugates (ADCs) are monoclonal antibodies that are attached to a chemotherapy drug. They are sometimes called targeted therapy drugs because they target certain proteins on the surface of cancer cells.

Brentuximab vedotin (Adcetris) is the ADC used to treat advanced HL. It attaches to the CD-30 protein that is found in high amounts on the surface of HL cells. Brentuximab vedotin may be used alone or in combination with chemotherapy. It is given through a needle in a vein (intravenously).

Brentuximab vedotin is used:

• along with the chemotherapy combination AVD (doxorubicin, vinblastine and dacarbazine) to treat advanced HL
• as consolidation therapy after a stem cell transplant when there is a high risk that HL will come back (relapse or recur) or continue to progress
• if HL comes back after a stem cell transplant
• if HL doesn’t respond to at least 2 types of combination chemotherapy in people who can’t have a stem cell transplant

The immune system normally stops itself from attacking normal cells in the body by using specific proteins called checkpoints. Checkpoints slow down or stop an immune system response. Some Hodgkin lymphoma cells sometimes use these checkpoints to hide and avoid being attacked by the immune system. Immune checkpoint inhibitors work by blocking the checkpoint proteins so immune system cells (called T-cells) attack and kill the cancer cells.

PD-1 is an immune checkpoint protein that stops T cells from attacking other cells in the body. It does this by attaching to PD-L1, a protein found on some normal cells and some cancer cells. Checkpoint inhibitor drugs may target either PD-1 or PD-L1 proteins.

The PD-L1 immune checkpoint inhibitors used for relapsed or refractory HL are:

• pembrolizumab (Keytruda)
• nivolumab (Opdivo)

These drugs are given through a needle into a vein (intravenously). You will have them once every 3 weeks until the disease starts to grow or spread, or until the side effects outweigh the benefits of having the treatment.

Side effects of chemoimmunotherapy include side effects of chemotherapy and side effects of immunotherapy. Tell your healthcare team if you have side effects that you think might be from chemoimmunotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

All drugs, including those used to treat cancer, are approved for use in Canada by Health Canada. If a drug is mentioned on cancer.ca, it means that Health Canada has approved the drug and pharmaceutical companies sell it in Canada. It does not mean that the drug is offered everywhere in Canada.

Paying for drugs is the responsibility of provincial and territorial health departments. Each health department makes its own decisions about which drugs to cover (pay for) in that province or territory. This means that a drug may be covered in one province, but not in others.

Your oncologist will talk to you about different drug treatments and what is available through your provincial or territorial drug program.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.