1. It takes a long time for some people to be diagnosed with Hodgkin’s lymphoma. Are there any new diagnostic tests that might help catch it earlier?
It’s true that a diagnosis of Hodgkin’s lymphoma can be delayed. This usually happens because the signs and symptoms associated with the disease can be nonspecific. The symptoms may overlap with more common causes such as infection or inflammation.
The gold standard for diagnosing Hodgkin’s lymphoma is a tissue biopsy to confirm the disease. There are no new diagnostic tests that are commercially available for a faster diagnosis.
However, many new investigational techniques are being developed. One is a method for detecting tumor cells and tumor DNA circulating in the bloodstream. Such techniques have the potential to allow for earlier diagnosis. They may also improve monitoring of lymphoma without the need for tissue biopsies.
2. What are the frontline treatments right now for stage 3 and 4 Hodgkin’s lymphoma? How well do these approaches work?
People with stage 3 and 4 classical Hodgkin’s lymphoma are considered to have advanced stage disease. There are several frontline treatment options. Your doctor will determine your treatment plan based on the extent of disease, specific prognostic factors, your age, and other health issues.
The most commonly used treatment is a chemotherapy regimen called “ABVD.” This is an acronym that stands for four medications: Adriamycin (doxorubicin), bleomycin, vinblastine, and dacarbazine. A PET/CT scan is often repeated after 2 months of therapy. If there’s an excellent response, bleomycin can be eliminated from later cycles of chemotherapy. Research shows this minimizes lung side effects.
People usually receive a total of 6 months of therapy. Other frontline chemotherapy options you may hear about include Stanford V or escalated BEACOPP. Recently, AVD with brentuximab vedotin has been approved as another treatment option.
Radiation is incorporated into some treatment plans after chemotherapy is complete. In general, these frontline regimens will cure about 50 to 80 percent of people, depending on various individual circumstances.
3. Are there any new breakthrough treatments for treating Hodgkin’s lymphoma? How close is the medical field to finding new or better treatment options?
Over the past eight years, three new drugs have been approved by the FDA for treating Hodgkin’s lymphoma: brentuximab vedotin, nivolumab, and pembrolizumab. Combinations of these drugs with chemotherapy are currently under study in clinical trials.
Other novel treatments are also being studied in clinical trials, with the hope that they will provide safe and effective options for therapy.
4. What is immunotherapy? Are there any types of immunotherapy available to treat Hodgkin’s lymphoma?
Immunotherapy is a type of treatment that uses the immune system to help the body fight cancer.
Two recently approved immunotherapy drugs for relapsed, or refractory, Hodgkin’s lymphoma are nivolumab and pembrolizumab. These are known as programmed death 1 (PD-1) inhibitors. They enable your immune system to better attack the lymphoma.
5. What is targeted therapy? Are there any types of targeted therapy available to treat Hodgkin’s lymphoma?
Targeted therapy is a type of treatment tailored to a specific aspect of the cancer. This type of therapy differs from traditional chemotherapy, which usually affects all rapidly dividing cells — not specific ones.
One type of targeted therapy approved to treat Hodgkin’s lymphoma is brentuximab vedotin. This medication is known as an “antibody-drug conjugate.” It combines an antibody targeting certain Hodgkin’s lymphoma cells with a toxic drug called monomethyl auristatin E (MMAE). The antibody attaches to the lymphoma cell and delivers MMAE into the cell. This has a therapeutic effect.
6. What is low dose chemotherapy and low dose radiation therapy? Are these options for some people with Hodgkin’s lymphoma?
There’s no specific definition of low dose chemotherapy or radiation therapy. These terms often refer to treatment that has been reduced from standard doses.
Changes to standard doses of treatment are usually advised if an individual can’t tolerate full doses. People may not be able to tolerate full doses due to side effects, laboratory abnormalities, other medical problems, or poor functional status.
7. Is there any new research on the benefits of lifestyle interventions to support people in treatment for Hodgkin’s lymphoma? Do we know anything about the benefits of things like nutrition, exercise, stress-relief, and sleep?
In general, I advise people to pursue a healthy balanced lifestyle, especially during lymphoma treatment. This includes maintaining good nutrition and getting exercise in moderation. You should also try to limit stress and get enough sleep.
Making healthy lifestyle choice provides the best chance for your body to maintain a healthy immune system. In turn, this may help you recover from the effects of lymphoma treatment.
Many institutions and cancer centers offer nutrition consultations. They may also offer integrative medicine classes or wellness opportunities.
8. What are the benefits and drawbacks of participating in a clinical trial for Hodgkin’s lymphoma treatments? How would I find a clinical trial and know if I’m a good candidate?
Participating in a clinic trial provides several benefits. One of the main benefits is getting access to a new lymphoma therapy or combination of therapies that you wouldn’t otherwise be able to try. Investigational therapies are often provided free of charge.
Participation in a clinical trial also helps improve our understanding of the disease. It may contribute to the approval of new therapies.
One of the potential drawbacks is that investigational drugs or combinations of drugs are generally not as well-studied as conventional treatments. They may also have the potential for increased toxicity.
Investigational programs are highly regulated. That means people usually have less flexibility about the about timing and location of treatment. ClinicalTrials.gov is an online database of clinical trials around the world.
Clinical trials may not be appropriate for everyone. If you’re interested in this option, discuss it first with your doctor.
9. Are there any other major breakthroughs in Hodgkin’s lymphoma research?
In general, Hodgkin’s lymphoma is a highly curable disease. Most ongoing research aims to investigate ways to balance the anti-lymphoma effect of medication with reducing side effects. Some of these techniques include minimizing or eliminating the use of traditional chemotherapy drugs and radiation. New techniques may also incorporate the newer targeted or immunotherapy drugs into treatment strategies.
Lauren Maeda is a board-certified medical oncologist/hematologist, specializing in the treatment of non-Hodgkin and Hodgkin lymphomas. She maintains an active clinical practice in her role as clinical assistant professor at Stanford University Medical Center in Stanford, California.