N it to win it.

Top Line: Immune checkpoint inhibitors are used for relapsed and refractory Hodgkin lymphoma (HL) but not as primary therapy for early stage disease.

The Study: NIVAHL was a randomized phase II trial from the German Hodgkin Study Group (GHSG) that investigated the use of nivolumab, doxorubicin, vinblastine, and dacarbazine (N-AVD) for early stage, unfavorable HL. In N-AVD, nivolumab is replacing bleomycin in the standard ABVD regimen. In fact, a larger phase 3 trial is actively comparing N-AVD and brentuximab plus AVD. In NIVAHL, all 109 patients received the N-AVD regimen, however they were randomized to either concomitant treatment with 4 cycles of N-AVD or sequential treatment with 4 cycles of nivo, 2 cycles of N-AVD, and 2 cycles of AVD. All patients received 30Gy involved site radiation after systemic therapy. In this final analysis, overall survival at 3 years was a whopping 100% with no deaths, and the rate of PFS was 99%. The single progression event occurred in the sequential group, and it was actually during single agent nivo. The patient was switched to BEACOPP + ISRT and had complete response. The most frequent nivo-related toxicity was hypothyroidism (21%). Interestingly, most of those with hypothyroidism were female (87%). There was no high grade lung or cardiac toxicity, and there were no second malignancies.

TBL: In NIVAHL, nivolumab and AVD followed by ISRT resulted in excellent disease control and survival with limited additional toxicity for patients with early stage, unfavorable HL. | Brockelmann, J Clin Oncol 2022