Immunotherapy for Hodgkin lymphoma

Immunotherapy is sometimes used to treat Hodgkin lymphoma (HL). Immunotherapy helps to strengthen or restore the immune system’s ability to fight cancer. Immunotherapy is sometimes called biological therapy.

You may have immunotherapy to:

• kill cancer cells
• strengthen your immune system
• stop cancer cells from growing and spreading

Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of immunotherapy. You may also receive other treatments.

The following types of immunotherapy drugs may be used to treat certain types of HL:

The immune system usually 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.

Immune checkpoint inhibitors are monoclonal antibodies, which find and attach to a specific antigen on a cancer cell.

Pembrolizumab (Keytruda) and nivolumab (Opdivo) are immune checkpoint inhibitors that may be used to treat classical HL that doesn’t respond to treatments or comes back after other treatments such as an autologous stem cell transplant and brentuximab vedotin (Adcetris). Pembrolizumab and nivolumab work by blocking the PD-1 checkpoint protein so immune system cells (called T cells) can attack and kill the cancer cells. They are given through a needle into a vein (intravenously) once every 3 weeks until the disease starts to grow or spread or until the side effects outweigh the benefits of having the treatment.

Immunomodulatory drugs modify (change) different parts of the immune system.

Lenalidomide (Revlimid) is a drug that boosts the immune system, helps stop the number of cancer cells from increasing and stops the growth of new blood vessels (called anti-angiogenesis). It is a pill taken by mouth.

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

Side effects of immunotherapy will depend mainly on the type of drug or drug combination, the dose, how it’s given and your overall health. Some common side effects of immunotherapy for HL are:

• fatigue
• flu-like symptoms, such as fever, chills, muscle and joint aches or pains, headache, nausea and vomiting or loss of appetite
• infection
• diarrhea
• swelling
• nausea
• constipation
• skin problems
• nerve pain, including peripheral neuropathy
• blood clots
• depression

Be sure to report side effects to the healthcare team. Side effects can happen any time during, immediately after or a few days or weeks after immunotherapy. Sometimes late side effects develop months or years later. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Your healthcare team is there to help. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

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

Find out more about immunotherapy. To make the decisions that are right for you, ask your healthcare team questions about immunotherapy.