Targeted therapy for childhood Hodgkin lymphoma

Targeted therapy is sometimes used to treat certain types of childhood Hodgkin lymphoma (HL). It uses drugs to target specific molecules (such as proteins) on or inside cancer cells. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells and limit harm to normal cells. Targeted therapy may also be called molecular targeted therapy.

Your child may have targeted therapy to treat:

• recurrent, or relapsed, HL
• childhood HL that no longer responds to chemotherapy

Your child’s healthcare team will consider the child’s personal needs to plan the drugs, doses and schedules of targeted therapy. Your child may also receive other treatments.

The main targeted therapy drugs used to treat childhood HL are rituximab (Rituxan), brentuximab vedotin (Adcetris) and bortezomib (Velcade). Immunotherapy drugs such as nivolumab (Opdivo), pembrolizumab (Keytruda) and atezolizumab (Tecentriq) may be used in some cases as part of a clinical trial.

Both rituximab and brentuximab vedotin are monoclonal antibodies. These drugs are designed to attach to a specific substance, or protein marker, on the surface of lymphoma cells.

Rituximab is designed to attach to CD20, which is one of the most common protein markers on lymphoma cells. CD20 is found on normal and abnormal B cells (B lymphocytes). Abnormal B cells are associated with HL. Rituximab works by stimulating the body’s immune system to attack and destroy the lymphocytes it attaches to. This drug is most often used to treat recurrent or refractory childhood nodular lymphocyte-predominant HL.

Brentuximab vedotin targets CD30, which is another protein that may be found on the surface of some lymphoma cells. This drug may be used to treat HL that has come back (recurred) after other treatments.

Bortezomib is a proteasome inhibitor. Proteasome inhibitors are a type of targeted therapy that block proteasomes. Proteasomes are a group of special proteins that cancer cells need to grow. Interfering with how proteasomes work can help stop the growth of cancer cells or destroy them. Bortezomib may be used to treat childhood Hodgkin lymphoma that comes back or doesn’t respond to other treatments. It is used along with chemotherapy.

Nivolumab, pembrolizumab and atezolizumab are immune checkpoint inhibitors that may be used to treat HL as part of a clinical trial. Immune checkpoint inhibitors are monoclonal antibodies, which are substances that find and attach to a specific antigen on cancer cells. The immune system normally stops itself from attacking normal cells in the body by using specific proteins called checkpoints, which are made by some immune system cells. Lymphoma cells sometimes use these checkpoints to avoid being attacked by the immune system. Immune checkpoint inhibitors are drugs that work by blocking the checkpoint proteins so immune system cells, such as T cells, can attack and kill the cancer cells.

Side effects can happen with any type of treatment for childhood HL, but every child’s experience is different. Some children have many side effects. Other children have only a few side effects.

Side effects can develop any time during, immediately after or a few days or weeks after targeted therapy. Sometimes late side effects develop months or years after targeted therapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of targeted therapy will depend mainly on the type of targeted therapy drug or drug combination given, the dose and the child’s overall health. The most common side effects of targeted therapy for childhood HL are:

• flu-like symptoms such as chills, fever, nausea, fatigue, skin rash and headache
• nausea and vomiting
• diarrhea
• fatigue
• changes in blood pressure
• bone marrow suppression
• peripheral nerve damage

Other side effects can develop months or years after treatment for childhood HL. Find out more about late effects of treatments for childhood HL.

Tell your child’s healthcare team if your child has these side effects or others you think might be from targeted therapy. The sooner you tell them of any problems, the sooner they can suggest ways to help your child deal with them.

Details on specific drugs change quite regularly. Find out more about sources of drug information and where to get details on specific drugs.

Find out more about targeted therapy. To make the decisions that are right for you, ask your child's healthcare team questions about targeted therapy.