To AVoiD bleomycin from Hodgkin’s regimen?

To improve long-term results in advanced Hodgkin’s lymphoma (HL) has been a continuous challenge from many years. Intensified chemotherapy regimen showed an advantage over standard regimen in terms of anti-tumoral activity, however haematological and non-haematological toxicities were significantly higher. Recently, brentuximab vedotin (BV) which is an antibody-drug conjugate targeting CD30 antigen, showed very promising results when given as single agent in patients with relapsed and refractory HL. Based on this hypothesis, Anas Younes and colleagues designed a phase I dose-escalation study in which BV was administered as front-line treatment either with the combination of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) regimen or AVD (ABVD without bleomycin). The aims of the study were to assess safety and efficacy of this drug in combination with chemotherapy in newlydiagnosed patients with advanced HL. The results showed that BV should not be given with bleomycin due to a high incidence of pulmonary toxicity. The trial also demonstrated that the combination of BV and AVD can be given safely and led to an impressive complete remission rate of 96%. Although we need to remain careful with these preliminary results, the data reported in the Lancet Oncology open a new therapeutic era in the field of HL, combining both less toxicity and higher efficacy.