SOHO State of the Art Updates and Next Questions | Early Stage Hodgkin Lymphoma-Are We Ready for Novel Agents?

Early-stage classic Hodgkin lymphoma (cHL) is characterized by high cure rates, with current treatment paradigms focused on personalizing therapy to balance disease control with the avoidance of long-term toxicity. Established response-adapted approaches utilize interim positron emission tomography to guide the intensity of standard doxorubicin, bleomycin, vinblastine, and dacarbazine-based chemotherapy with or without radiotherapy (RT). Improved response rates in advanced stage cHL with brentuximab vedotin (BV), pembrolizumab, and nivolumab have prompted the investigation of these novel agents in early stage cHL. Recent phase II clinical trials such as BREACH and NIVAHL, both including RT, demonstrate that integrating BV or nivolumab into combined modality therapy yields outstanding interim complete response rates and progression-free survival. Other small studies exploring the omission of RT have shown that BV-based regimens alone yield 2-year progression-free survival rates ranging from 91% to 97%. Emerging strategies are evaluating the role of novel agents as consolidation therapy or in immunotherapy-only induction to further reduce cytotoxic exposure. These promising outcomes need validation from ongoing randomized phase III trials such as RADAR and AHOD 2131. Refined risk stratification through emerging biomarkers including circulating tumor DNA and total metabolic tumor volume may help identify high risk patients who will most benefit from novel agents, individualizing therapy, and optimizing global access.