Given the data from SWOG 1826 suggesting that Nivo-AVD is likely the preferred regimen for advanced Hodgkin lymphoma patients, are there scenarios where alternative regimens may still be preferred?

Unless there was a contradiction to nivolumab (e.g., an active autoimmune disease), I would always favor N-AVD over BV-AVD- particularly in older patients.

N+AVD is a very appropriate consideration, based on S1826, for many patients, and certainly not all patients with advanced-stage cHL. Enrollment required a performance status of <=2 – frail patients may not tolerate such treatment and may require a ‘gentler’ approach such as the BV-AVD-BV ‘sandwich’ (Evens et al., PMID 30179569). Patients without adequate LV function will require a non-anthracycline-based strategy. And patients with autoimmune comorbid conditions that preclude the safe administr...

I would use a brentuximab vedotin-based regimen rather than N-AVD in patients with active autoimmune disease in the first-line setting. I have not used the BrECADD regimen yet, but I am open to using it in young, fit patients who have a reason to need a shorter duration of therapy. I am cautious about using BV-based regimens in patients whose jobs or hobbies would be impacted by peripheral neuropathy (such as a musician or athlete).