Loading
9 standard-of-care settings across 4 lines and 3 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
| Line | All comers | Age group | FRα |
|---|---|---|---|
| Screening, prevention and diagnosis | 1 | · | · |
| Advanced, first line | 4 | 1 | · |
| Special situations | · | · | 1 |
| Other settings | 1 | 1 | · |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Staging and risk | FDG-PET/CT with Lugano staging, International Prognostic Score, fertility counselling and cardiac and pulmonary baselines. | NCCN Guidelines: Hodgkin Lymphoma | 80 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | First line, intensive European option | BrECADD for four to six cycles guided by interim PET (GHSG HD21), replacing escalated BEACOPP. | NCCN Guidelines: Hodgkin Lymphoma | 83 | |
| All comers | Advanced Hodgkin lymphoma in the United States: nivolumab with AVD | SWOG S1826 randomised 994 patients aged 12 and over with untreated stage III or IV classical Hodgkin lymphoma to nivolumab with AVD or to brentuximab vedotin with AVD, the regimen that had itself displaced ABVD. Two-year progression-free survival was 92 against 83 per cent (hazard ratio 0.45), and any-grade peripheral neuropathy was 28.1 against 54.2 per cent. It is the first trial in this disease to include adolescents and adults in a single protocol, and the FDA approved nivolumab with doxorubicin, vinblastine and dacarbazine for previously untreated stage III or IV classical Hodgkin lymphoma in adults and children of 12 and over on 20 March 2026, converting the two earlier relapsed-disease accelerated approvals to traditional approval at the same time. It is a genuinely gentler regimen as well as a more effective one: less neuropathy, less growth-factor requirement, and no bleomycin. The subset analysis of the 99 eligible patients aged 60 and over reported two-year progression-free survival of 89 per cent with nivolumab-AVD against 64 per cent with brentuximab-AVD (hazard ratio 0.24) and two-year overall survival of 96 against 85 per cent (hazard ratio 0.16), with non-relapse mortality of 6 against 16 per cent, 55 per cent discontinuing brentuximab vedotin against 14 per cent discontinuing nivolumab, and six cycles delivered without dose reduction in 69 against 26 per cent. That matters, because older patients tolerate brentuximab-AVD badly and are the group in which first-line treatment most often fails. What is not yet known: overall survival has not separated, follow-up is short for a disease measured in decades, and the long-term consequences of PD-1 blockade in a 20-year-old who will live another 60 years are unknown. That last point is the honest counter-argument to adopting it everywhere. | SWOG S1826NivolumabBrentuximab vedotinDoxorubicinVinblastineDacarbazineABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens)British and American lymphoma practice: where they differ, and whySWOG S1826: nivolumab plus AVD chemotherapy versus brentuximab-AVD for advanced Hodgkin lymphoma in adolescents and adults | NCCN · Category 1 | 98 |
| All comers | Advanced Hodgkin lymphoma in Germany and much of Europe: PET-guided BrECADD | GHSG HD21 randomised about 1,500 patients aged 18 to 60 with untreated advanced-stage classical Hodgkin lymphoma to PET-guided BrECADD or PET-guided escalated BEACOPP. Four-year progression-free survival was 94.3 against 90.9 per cent (hazard ratio 0.66) and treatment-related morbidity, a composite of organ toxicity, infection and haematological toxicity, was 42 against 59 per cent. BrECADD replaces the bleomycin, vincristine and procarbazine of escalated BEACOPP with brentuximab vedotin and dacarbazine, which removes the lung toxicity, most of the neuropathy and much of the infertility risk, and PET guidance means most patients receive four cycles rather than six. This is the highest progression-free survival reported in advanced Hodgkin lymphoma. It is also intensive treatment that requires an experienced unit, hospital admission for febrile neutropenia in a substantial minority, and growth-factor support throughout. The earlier PET-guided BEACOPP trials, HD18 and AHL2011, established the principle: HD18 reduced treatment from eight cycles to four in PET-negative patients, and AHL2011 switched PET-negative patients from escalated BEACOPP to ABVD, in both cases without losing disease control. | GHSG HD21Brentuximab vedotinEtoposideCyclophosphamideDoxorubicinDacarbazineDexamethasoneProcarbazineBleomycinVincristineABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens)FDG PETPET-adapted (response-adapted) therapyFertility before lymphoma treatment: what to ask for, and whenGHSG HD21: PET-guided BrECADD versus escalated BEACOPP in advanced-stage classical Hodgkin lymphoma | GHSG HD21; ESMO; HD18 and AHL2011 for the PET-guided principle | 86 |
| All comers | Advanced Hodgkin lymphoma with ABVD and brentuximab: what the earlier standards showed | The two regimens that the current standards displaced are still used, and still reasonable where the newer ones are not available. ABVD with PET adaptation. RATHL enrolled 1,214 patients and showed that in those whose PET after two cycles was negative, bleomycin could be omitted from cycles 3 to 6 without loss of control: three-year progression-free survival 85.7 per cent for continued ABVD against 84.4 per cent for AVD, with less lung toxicity. This remains common British practice and is a perfectly defensible treatment. Brentuximab vedotin with AVD. ECHELON-1 randomised 1,334 patients with untreated stage III or IV disease to A+AVD or ABVD: two-year modified progression-free survival was 82.1 against 77.2 per cent (hazard ratio 0.77) and, at six years, overall survival was 93.9 against 89.4 per cent (hazard ratio 0.59). It is the only first-line trial in advanced Hodgkin lymphoma to show an overall survival advantage. The cost is peripheral neuropathy, which is commoner and more severe than with ABVD; in SWOG S1826 any-grade peripheral neuropathy was 54.2 per cent with brentuximab-AVD against 28.1 per cent with nivolumab-AVD. Growth-factor support is mandatory. In England, NICE TA1059 recommends brentuximab vedotin with doxorubicin, dacarbazine and vinblastine for untreated stage 3 or 4 CD30-positive Hodgkin lymphoma in adults, so this is the regimen that is funded first line; there is no NICE appraisal of nivolumab with AVD. Older and frail patients tolerate none of these well. Options are ABVD with bleomycin omitted, sequential brentuximab vedotin before and after AVD, or a reduced-intensity regimen, and the choice is made on comorbidity rather than on chronological age. | RATHLECHELON-1Brentuximab vedotinDoxorubicinBleomycinVinblastineDacarbazineGrowth factors: G-CSF and febrile neutropenia preventionABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens)RATHL: adapted treatment guided by interim PET-CT in advanced Hodgkin lymphomaECHELON-1: brentuximab vedotin replacing bleomycin in first-line chemotherapy for advanced Hodgkin lymphoma | NCCN · Category 1 | 90 |
| Age group | First line, adults and adolescents 12 and over | Nivolumab with AVD for six cycles (SWOG S1826, preferred); brentuximab vedotin with AVD (ECHELON-1) as an alternative; PET-adapted ABVD with bleomycin omission after two cycles (RATHL) where antibodies are unavailable. | NCCN Guidelines: Hodgkin Lymphoma | 98 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| FRα | Older or frail patients | AVD with brentuximab vedotin sequenced before and after, or nivolumab-AVD; avoid bleomycin and BEACOPP. | NCCN Guidelines: Hodgkin Lymphoma | 98 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | End of treatment | PET-directed consolidation radiotherapy only for residual PET-positive bulky disease; long-term survivorship follow-up. | NCCN Guidelines: Hodgkin Lymphoma | 93 | |
| Age group | Children | Response-adapted Children's Oncology Group or EuroNet regimens; brentuximab vedotin with AVD in advanced paediatric disease; radiotherapy for slow responders only. | NCCN Guidelines: Hodgkin Lymphoma | 83 |
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.