Immunotherapy for Hodgkin Disease
Immunotherapy is the use of medicines to stimulate a person’s own immune system to recognize and destroy cancer cells more effectively. Immunotherapy can be used to treat some people with Hodgkin disease.
Antibodies are proteins made by your immune system to help fight infections. Man-made versions, called monoclonal antibodies (mAbs), can be designed to attack a specific target, such as a substance on the surface of lymphocytes (the cells in which Hodgkin disease starts).
Some mAbs are now being used to treat Hodgkin disease.
Brentuximab vedotin (Adcetris): This drug is an anti-CD30 antibody attached to a chemotherapy drug. Hodgkin disease cells usually have the CD30 molecule on their surface. The antibody acts like a homing signal, bringing the chemo drug to the lymphoma cells, where it enters the cells and makes them die when they try to divide into new cells.
This drug has been shown to help many people whose Hodgkin disease has come back after other treatments, including a stem cell transplant, as well as people who can’t have a stem cell transplant. It is also being studied to see if it can be given with chemotherapy and if can be helpful earlier in the course of the disease.
Brentuximab is infused into a vein (IV) every 3 weeks. Common side effects include nerve damage (neuropathy), low blood cell counts, fatigue, fever, nausea and vomiting, infections, diarrhea, and cough. Rarely, serious side effects occur during infusions, such as trouble breathing and low blood pressure.
Rituximab (Rituxan): This antibody attaches to a substance called CD20 found on some types of lymphoma cells, which seems to kill the lymphoma cell. Rituximab may be used to treat nodular lymphocyte predominant Hodgkin disease (NLPHD), often with chemotherapy and/or radiation therapy.
Rituximab is given as an IV infusion in the doctor’s office or clinic. When it is used by itself, it is usually given once a week for 4 weeks, which may then be repeated several months later. When it is combined with chemotherapy, it is most often given on the first day of each chemo cycle.
Common side effects are usually mild but can include chills, fever, nausea, rashes, fatigue, and headaches. Rarely, more severe side effects occur during infusions, such as trouble breathing and low blood pressure. Even if these symptoms occur during the first infusion, it is very unusual for them to recur with later doses. Rituximab can cause prior hepatitis B infections to become active again, sometimes leading to severe liver problems or even death. Your doctor will probably check your blood for signs of hepatitis before starting this drug. This drug can also increase the risk of certain infections for several months after the drug is stopped.
Immune checkpoint inhibitors
An important part of the immune system is its ability to keep itself from attacking normal cells in the body. To do this, it uses “checkpoints” – molecules on immune cells that need to be turned on (or off) to start an immune response. Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. But newer drugs that target these checkpoints hold a lot of promise as cancer treatments.
Nivolumab (Opdivo) targets PD-1, a protein on immune system cells called T cells that normally helps keep these cells from attacking other cells in the body. By blocking PD-1, this drug boosts the immune response against cancer cells. This can shrink some tumors or slow their growth.
This drug can be used in people with classic Hodgkin disease whose cancer has grown or returned after treatment with a stem cell transplant and brentuximab vedotin.
Nivolumab is given as an intravenous (IV) infusion every 2 weeks.
Possible side effects
Side effects of this drug can include fatigue, cough, nausea, itching, skin rash, loss of appetite, joint pain, constipation, and diarrhea.
Other, more serious side effects occur less often. This drug works by basically removing the brakes on the body’s immune system. Sometimes the immune system starts attacking other parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, kidneys, or other organs.
It’s very important to report any new side effects to your health care team promptly. If serious side effects do occur, treatment may need to be stopped and you may get high doses of corticosteroids to suppress your immune system.
Last Medical Review: July 10, 2014 Last Revised: May 23, 2016
- Chemotherapy for Hodgkin Disease
- Radiation Therapy for Hodgkin Disease
- Immunotherapy for Hodgkin Disease
- High-dose Chemotherapy and Stem Cell Transplant for Hodgkin Disease
- Treating Classic Hodgkin Disease, by Stage
- Treating Nodular Lymphocyte Predominant Hodgkin Disease (NLPHD)
- Treating Hodgkin Disease in Children
- Hodgkin Disease in Pregnancy