Immune Checkpoint Inhibitors for Classical Hodgkin Lymphoma in Brentuximab Vedotin-naïve Patients: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Key Message

The evidence on the treatment of Hodgkin Lyphoma in brentuximab vedotin-naïve patients with immune checkpoint inhibitors is sparse. One set of evidence-based guidelines was found that provided recommendations on diagnosing, treating, and following patients with early stage, intermediate stage, or advanced stage classical Hodgkin lymphoma. Based on evidence of limited quality, quantity, and consistency, the guidelines recommend treating eligible adults with immune checkpoint inhibitors such as nivolumab and pembrolizumab for relapsed or refractory Hodgkin lymphoma following autologous hematopoietic stem cell transplantation with or without brentuximab vedotin. Of note, the recommendation was not specific to brentuximab vedotin-naïve patients and sections of the guideline document remain under development. The guidelines indicated that immune checkpoint inhibitors may be considered as an option for patients who are ineligible for stem cell transplantation due to comorbidity or failed second-line chemotherapy. Nivolumab and pembrolizumab may also be used for patients following allogeneic stem cell transplantation. Guidance was provided suggesting that nivolumab and pembrolizumab may be offered as palliative therapy options for patients older than 60 years who were previously treated with brentuximab vedotin. The authors followed established processes for developing the guidelines, however there were some gaps in reporting that made it challenging to assess all aspects of the development processes. The guidelines were written for the United States population and as such may not be applicable to the Canadian population. There was no relevant primary evidence regarding the clinical effectiveness or cost-effectiveness of immune checkpoint inhibitors in brentuximab vedotin-naïve patients who either had failed or were not eligible for auto-SCT.