[Frontline therapy for classical Hodgkin lymphoma patients].

Abstract

FRONTLINE THERAPY FOR CLASSICAL HODGKIN LYMPHOMA PATIENTS. Upfront first-line chemotherapy is indicated for all features of classical Hodgkin's lymphoma, followed by involved node radiotherapy in early stages; the ABVD protocol (doxorubicin (Adriamycin), bleomycin, vinblastine, dacarbazine) is the international standard of care. The 7-agent BEACOPP protocol (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine (Oncovin), procarbazine, prednisone) is used in advanced stages in its «escalated» version (BEAesc). During the 2010 decade, it has been demonstrated that strategies guided by positron emission tomography (PET) allows optimizing the benefit/risk ratio of the treatment by decreasing the intensity of therapies for good responders and intensifying treatment of poor responders. Thus, early PET response evaluation is now essential to adapt the treatment intensity. Despite these major advances, several issues remain, including the management of acute and long-term side effects of first-line treatments, the better options for refractory patients, the place and optimization of radiotherapy, and the place for new therapeutic agents such as the anti-CD30 conjugate antibody (brentuximab vedotin) and PD-1 inhibitors in the first-line treatment setting.