Is your standard of care for newly diagnosed advanced classical Hodgkin now nivolumab-AVD based on SWOG 1826?

I think the new standard of care for newly diagnosed patients with advanced classical Hodgkins Lymphoma is now nivolumab-AVD based on the early data from SWOG 1826. While we often wait for more mature data, the early improvement in PFS and the more favorable toxicity profile of this regimen over BvAVD should make this the new standard of care and should lead to swift approval by the FDA and adoption in the NCCN guidelines as at least an option as a preferred regimen.

Further studies now should fo...

To me, yes. The magnitude of benefit seen with nivo-AVD over BV-AVD exceeds that seen in ECHELON-1, and it is also much more tolerable in elderly patients than BV-based frontline treatment. In my mind, anyone who does not have an absolute contraindication to PD-1 blockade and who has advanced-stage disease should be treated with nivo-AVD.

I recommend N-AVD for most patients with newly diagnosed advanced-stage cHL. In addition to the marked efficacy of this regimen, I have found it to be better tolerated than BV-AVD in most patients. I do not use growth factor in the majority of patients, unless they have had an episode of febrile neutropenia. I am especially in favor of N-AVD in older patients. I have treated multiple patients in their 60s and 70s with this regimen, and most have been able to complete the 6 cycles without delay o...

There is no single standard of care for advanced-stage cHL. But S1826 has clearly established N+AVD as a standard regimen and one that is relevant to discuss with the majority of patients with newly diagnosed advanced-stage classical Hodgkin lymphoma.

Agree with the above for the moment.

The future should invest in less toxic regimens that are chemo-free or chemo-lite; Nivo + BV and/or cladribine + BV + HDACi.