Sven Borchmann1,2,3, Andreas Engert1, Boris Böll1. 1. Department I of Internal Medicine, German Hodgkin Study Group (GHSG). 2. Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital of Cologne. 3. Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany.
Abstract
PURPOSE OF REVIEW: We aim to summarize the current knowledge on the treatment of elderly Hodgkin lymphoma patients with a focus on evidence from clinical trials and novel drugs. RECENT FINDINGS: For elderly Hodgkin lymphoma patients above 60 years without precluding comorbidities a curative treatment approach is warranted. Early favorable stage patients should receive two cycles of multiagent chemotherapy followed by 20 Gy localized radiotherapy. Early unfavorable stage patients should receive four cycles of multiagent chemotherapy followed by 30 Gy localized radiotherapy. For advanced stage patients six cycles of multiagent chemotherapy can be recommended and should be followed by localized radiotherapy on residual disease manifestations. Relapsed or refractory patients should be treated in an individually tailored approach that considers both the patient's objectives and comorbidities. The antibody-drug conjugate brentuximab vedotin is a very effective option for elderly patients with a high response rate albeit limited durability. Anti-programed cell death protein 1 antibodies might also be effective in elderly Hodgkin lymphoma patients with a mechanism of action distinct from chemotherapy. SUMMARY: In conclusion, the goal of treatment in newly diagnosed elderly Hodgkin lymphoma patients is curative whenever possible and prospective and retrospective evidence has shown that this is feasible for all disease stages with a variety of multiagent chemotherapy regimen. Relapsed and refractory elderly Hodgkin lymphoma patients can mostly only be treated with the goal of palliation. However, it remains to be seen if novel substances and new combination regimen are able to change that.
PURPOSE OF REVIEW: We aim to summarize the current knowledge on the treatment of elderly Hodgkin lymphomapatients with a focus on evidence from clinical trials and novel drugs. RECENT FINDINGS: For elderly Hodgkin lymphomapatients above 60 years without precluding comorbidities a curative treatment approach is warranted. Early favorable stage patients should receive two cycles of multiagent chemotherapy followed by 20 Gy localized radiotherapy. Early unfavorable stage patients should receive four cycles of multiagent chemotherapy followed by 30 Gy localized radiotherapy. For advanced stage patients six cycles of multiagent chemotherapy can be recommended and should be followed by localized radiotherapy on residual disease manifestations. Relapsed or refractory patients should be treated in an individually tailored approach that considers both the patient's objectives and comorbidities. The antibody-drug conjugate brentuximab vedotin is a very effective option for elderly patients with a high response rate albeit limited durability. Anti-programed cell death protein 1 antibodies might also be effective in elderly Hodgkin lymphomapatients with a mechanism of action distinct from chemotherapy. SUMMARY: In conclusion, the goal of treatment in newly diagnosed elderly Hodgkin lymphomapatients is curative whenever possible and prospective and retrospective evidence has shown that this is feasible for all disease stages with a variety of multiagent chemotherapy regimen. Relapsed and refractory elderly Hodgkin lymphomapatients can mostly only be treated with the goal of palliation. However, it remains to be seen if novel substances and new combination regimen are able to change that.
Authors: Florian Lüke; Dennis C Harrer; Karin Menhart; Daniel Wolff; Ernst Holler; Dirk Hellwig; Wolfgang Herr; Matthias Grube; Martin Vogelhuber; Albrecht Reichle; Daniel Heudobler Journal: Front Pharmacol Date: 2021-06-18 Impact factor: 5.810