Hodgkin’s lymphoma, with immunotherapy the risk of the disease progressing decreases – breaking latest news

For Hodgkin’s lymphoma the combination of chemotherapy and radiotherapy is still the standard treatment with very high chances of recovery. From the annual congress of the American Society of Clinical Oncology (Asco), underway in Chicago, comes an important piece of news for those patients, adolescents and adults, with advanced stage cancer: the immunotherapy drug nivolumab, added to chemotherapy, significantly reduces both the risk of disease progression and death of the patient (which decreases by 52%). a step forward so important as to have been selected among the four main studies (out of over 5 thousand) that are presented in the plenary session, the one dedicated to the most important studies, because potentially capable of changing standard first-line therapy for patients with advanced stage Hodgkin’s lymphoma, which is very common in adolescents and young adults,” he comments Paul Corradini, president of the Italian Society of Hematology (SIE) -. Thanks to the new therapy being tested, there seems to be a glimpse of the possibility of obtaining cure in more than 90% of patients.

Therapy today

What treatment do patients with a diagnosis of Hodgkin’s lymphoma receive today? A combination of chemotherapy and radiation therapy in the initial stages (I and II), with the number of chemo cycles and radio doses defined on the basis of very specific criteria and the aggressiveness of the tumor – he explains Francesco Passamonti, director of Hematology at the IRCCS Policlinico Foundation in Milan —. While in the advanced stages the standard care provides chemotherapy alone according to the so-called ABVD scheme (A stands for adriamycin, a synonym for doxorubicin, bleomycin, vinblastine and dacarbazine) for six cycles in stage III patients and the binding of the monoclonal antibody Brentuximab Vedotin and AVD chemotherapy (without bleomycin) for six cycles. These are treatments already available in Italy, capable of inducing cures and lasting remissions of the disease in over two thirds of patients. If these first-line treatments then fail, and the disease recurs, we proceed with an autologous stem cell transplant. A significant number of patients with relapsed or refractory (i.e., unresponsive to all of these treatments) Hodgkin’s lymphoma relapse, which, in most cases, occurs within one to three years after transplantation. Several new ones have become available in recent years smart biological drugs who manage to heal a substantial proportion of patients, in whom the disease is no longer controlled by traditional treatments. Which strategies to choose, among the many available, depends on the tumor subtypeits characteristics, the patient’s age and many other parameters that must be considered on a case-by-case basis underlines Corradini, director of Hematology at the IRCCS Foundation National Cancer Institute (Int) in Milan.

What changes with the new treatment and how it works

The new research presented at the American conference involved about 970 patients (aged 12 and up) with advanced Hodgkin lymphoma (ie stage III and IV) not previously treated. SWOG S1826 a phase three study (the last before the definitive approval and entry into the market of a drug) comparing the current standard therapy for these patients (i.e. brentuximab and the AVD chemotherapy scheme) with the new treatment (nivolumab and AVD) – Passamonti clarifies -: the results indicate that with the latter progression-free survival can be further improved, from 84% to 94% one year after treatment. Nivolumab is an immunotherapy drug already available in our country for various types of cancer and is also reimbursed for Hodgkin’s lymphoma with a high risk of recurrence or progression, following autologous stem cell transplantation. The treatment is well tolerated because the adverse events were mainly mild and easily manageable: In particular it is observed minimal reduction in thyroid function, well controllable by taking thyroid hormone tablets (levothyroxine) and lung disorders or respiratory infections. An important fact because we expect that this cure will become standard therapy in the near future adds Corradini.

A cancer that mainly affects young people

There are about 1,200 new cases of Hodgkin’s lymphoma diagnosed every year in Italy: they are blood cancers that mainly affect young people (before the age of 45, more frequent in the age group around 20, but can rarely develop even beyond 60) and about 90% of patients are alive and can be considered cured five years after diagnosis. Lymphomas are divided into two macro-groups: Hodkgin’s lymphoma (from the name of the English doctor Sir Thomas Hodgkin, who was the first to describe it in the first half of the 19th century) and non-Hodkgin’s lymphomas (all the others) – recalls Passamonti —. It is a group of heterogeneous diseases, including various subtypes, even very different from each other, which can have a different evolution and aggressiveness and which therefore require specific treatments depending on the single pathology. Today, thanks to the progress of scientific research, modern therapies allow in many cases to obtain healing even if the disease has spread to other organs. Or at least keep it in remission for many years.

Symptoms and diagnostic tests

What are the symptoms that should make you suspicious? Unfortunately it is difficult to reach an early diagnosis of a blood tumor because the initial signals are always rather vague and not very specific and could also be a sign of many other pathologies – concludes Corradini -. It is important to talk to a doctor if you have: fever or low-grade fever (especially in the afternoon or at night) e a sense of weakness which last without apparent cause for more than two weeks; loss of appetite and significant and unjustified weight loss; formation of spontaneous bruising or bruising; swelling, often painless, of a lymph node superficial neck, axillary or inguinal. They can also be present excessive sweatingespecially at night, which forces you to change clothes and a persistent itch spread over the whole body. In the presence of suspicious symptoms, it is advisable to go to the general practitioner who, after the visit, can prescribe tests (more or less specific blood tests depending on the suspicions) and, if it deems it appropriate, suggest to consult a hematologist for a more in-depth evaluation and possible execution of further investigations (such as a biopsy of bone marrow or an enlarged lymph node).