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Background <p>Curative first-line treatment of advanced-stage classical Hodgkin lymphoma (cHL) has historically been defined by ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine ) and escalated BEACOPP (eBEACOPP; bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone). Positron-emission tomography (PET)-adapted strategies enabled response-guided escalation and deescalation, while antibody-based regimens have again shifted the risk–benefit profile. Nivolumab-AVD (N-AVD; nivolumab, doxorubicin, vinblastine, dacarbazine) and brentuximab-ECADD (BrECADD; brentuximab-vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine, dexamethasone) are two effective contemporary approaches that may serve as new standards for patients with advanced cHL, depending on regional practice patterns.</p> Objective <p>This work aims to position&#xa0;N-AVD and BrECADD based on the SWOG S1826 and German Hodgkin Study Group (GHSG) HD21 trials, discuss practical treatment selection, and outline GHSG-driven future concepts integrating PET and circulating tumor DNA (ctDNA).</p> Materials and methods <p>We performed a narrative review of pivotal randomized trials and relevant subgroup/biomarker data (PET, ctDNA) in advanced-stage cHL.</p> Results and conclusion <p>Compared to earlier regimens, N‑AVD and BrECADD combine higher efficacy with a favorable side effects profile. In the phase&#xa0;III S1826 trial, N‑AVD improved progression-free survival versus brentuximab-AVD (BV-AVD; brentuximab-vedotin, nivolumab, doxorubicin, vinblastine, dacarbazine), with tendential benefits in several subgroups, including older patients. However, the PET-based response evaluation under PD‑1 inhibition is limited, and long-term tolerability assessment requires structured surveillance for immune-related adverse events. In the phase&#xa0;III HD21 trial, PET-guided BrECADD reduced treatment-related morbidity compared with eBEACOPP and achieved excellent PFS; fertility recovery and patient-reported outcomes further support a&#xa0;favorable patient-centered profile. Ongoing GHSG programs (Pembro-FLASH, QUANTIFY) and integrated ctDNA/quantitative PET approaches may refine risk stratification, enable safe de-intensification, and support step-up strategies reserving intensified chemotherapy for patients who truly need it.</p>

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Nach ABVD und BEACOPP: N-AVD und BrECADD – neue Schemata, alte Diskussion?

  • 期刊论文

  • 发表日期：

    2026年5月26日

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  • Justin Ferdinandus,
  • Julia Meissner,
  • Jan Bögeholz,
  • Peter Borchmann

摘要

Background

Curative first-line treatment of advanced-stage classical Hodgkin lymphoma (cHL) has historically been defined by ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine ) and escalated BEACOPP (eBEACOPP; bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone). Positron-emission tomography (PET)-adapted strategies enabled response-guided escalation and deescalation, while antibody-based regimens have again shifted the risk–benefit profile. Nivolumab-AVD (N-AVD; nivolumab, doxorubicin, vinblastine, dacarbazine) and brentuximab-ECADD (BrECADD; brentuximab-vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine, dexamethasone) are two effective contemporary approaches that may serve as new standards for patients with advanced cHL, depending on regional practice patterns.

Objective

This work aims to position N-AVD and BrECADD based on the SWOG S1826 and German Hodgkin Study Group (GHSG) HD21 trials, discuss practical treatment selection, and outline GHSG-driven future concepts integrating PET and circulating tumor DNA (ctDNA).

Materials and methods

We performed a narrative review of pivotal randomized trials and relevant subgroup/biomarker data (PET, ctDNA) in advanced-stage cHL.

Results and conclusion

Compared to earlier regimens, N‑AVD and BrECADD combine higher efficacy with a favorable side effects profile. In the phase III S1826 trial, N‑AVD improved progression-free survival versus brentuximab-AVD (BV-AVD; brentuximab-vedotin, nivolumab, doxorubicin, vinblastine, dacarbazine), with tendential benefits in several subgroups, including older patients. However, the PET-based response evaluation under PD‑1 inhibition is limited, and long-term tolerability assessment requires structured surveillance for immune-related adverse events. In the phase III HD21 trial, PET-guided BrECADD reduced treatment-related morbidity compared with eBEACOPP and achieved excellent PFS; fertility recovery and patient-reported outcomes further support a favorable patient-centered profile. Ongoing GHSG programs (Pembro-FLASH, QUANTIFY) and integrated ctDNA/quantitative PET approaches may refine risk stratification, enable safe de-intensification, and support step-up strategies reserving intensified chemotherapy for patients who truly need it.