Targeted and immunotherapy drugs for Hodgkin lymphoma

You might have targeted or immunotherapy drugs as part of your treatment for Hodgkin lymphoma.

Targeted cancer drugs work by targeting the differences in cancer cells that help them grow and survive.

Immunotherapy uses the immune system to fight cancer. It works by helping the immune system recognise and attack cancer cells.

Some drugs work in more than one way. They are targeted and work with the immune system.

When you might have targeted cancer drugs and immunotherapy for Hodgkin lymphoma

You might have a targeted cancer drug when treatment isn't working. Or if the cancer has come back (relapsed Hodgkin lymphoma).

You might also have a targeted cancer drug if you have nodular lymphocyte predominant Hodgkin lymphoma (NPHL). This is a rare type of Hodgkin lymphoma.

Types of targeted drugs for Hodgkin lymphoma

Monoclonal antibodies (MABs) are the most common type of targeted drug used for Hodgkin lymphoma.

Brentuximab and rituximab are a type of monoclonal antibody. They target specific proteins on lymphoma cells and help the immune system to find these cells and kill them. Because of the way they work they are sometimes called targeted immunotherapy drugs.

Brentuximab

Brentuximab targets a protein called CD30, which is found on Hodgkin lymphoma cells. Brentuximab sticks to the CD30 protein and delivers a drug to the cell. The drug then kills the cell.

You might have brentuximab if your treatment isn’t working, or if the cancer has come back.

To have brentuximab you need to first have had one of the following:

• a stem cell transplant that hasn’t worked
• two other treatments if you couldn’t have a stem cell transplant

Rituximab

Rituximab targets a protein called CD20, which is found on white blood cells called B cells. This then flags the cells to the immune system, which picks out the cells and kills them.

You might have this as your first treatment if you have advanced stage NPHL or relapsed NPHL.

You usually have rituximab with chemotherapy. You might have it with a combination of chemotherapy drugs and a steroid, such as:

• R-CHOP - rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone
• R-ABVD - rituximab, doxorubicin, bleomycin, vinblastine and dacarbazine
• R-CVP - rituximab, cyclophosphamide, vincristine and prednisolone
• R-CVinbP - rituximab, cyclophosphamide, vinblastine and prednisolone

Types of immunotherapy drugs for Hodgkin lymphoma

Pembrolizumab and nivolumab are types of immunotherapy. They stimulate the body’s immune system to fight cancer cells.

Pembrolizumab

Pembrolizumab targets and blocks proteins called PD-1 on the surface of certain immune cells called T cells. Blocking PD-1 triggers the T cells to find and kill cancer cells.

You might have pembrolizumab if you:

• have had at least 2 previous treatments

• have already had brentuximab

• can't have a stem cell transplant using your own cells

Nivolumab

Nivolumab also blocks the PD-1 protein that stops the immune system from working properly and attacking cancer cells.

You might have nivolumab if either:

• your previous treatment hasn’t worked very well

• your lymphoma has come back

Before you have nivolumab you must have had both:

• brentuximab

• a stem cell transplant if you were able to have one

How you have targeted and immunotherapy drug treatment

Into the bloodstream

You usually have targeted and immunotherapy drugs through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You may need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

As an injection under the skin

You might have rituximab as an injection under the skin. This is called a subcutaneous injection. You can only have rituximab as an injection if you’ve had at least one dose of rituximab into your bloodstream. And you didn’t have any serious side effects while you had it.

You might have a dull ache for a short time after this type of injection but it doesn’t usually hurt much. The skin in the area may go red and itchy for a while.

Side effects

Everyone is different and the side effects vary from person to person. The side effects you may have depend on:

• which cancer drug you have

• whether you have it alone or with other cancer drugs

• the amount of cancer drug you have (the dose)

• your general health

A side effect may get better or worse during your treatment. Or more side effects may develop as the treatment goes on.

A common side effect of some monoclonal antibodies is an allergic reaction to the drug. This reaction is most likely to happen during your first treatment. Your nurse might give you medicines before treatment to prevent an allergic reaction.

Possible side effects for targeted and immunotherapy drugs include:

• skin changes such as red and sore skin or an itchy rash

• loose watery poo (diarrhoea)

• tiredness

• flu-like symptoms such as chills, fever or dizziness

• feeling or being sick

Targeted and immunotherapy drugs can cause different side effects. Some of these can be serious. Your doctor or nurse will talk to you about this. Always tell them about any side effects you have and follow the advice they give you. 

For more information about the side effects of your treatment, go to the individual drug pages. 

Research into immunotherapy and targeted drugs for Hodgkin lymphoma

You might have treatment as part of a clinical trial for Hodgkin lymphoma.

Researchers are looking at:

• having immunotherapy or targeted cancer drugs as the first treatment for Hodgkin lymphoma

• new targeted and immunotherapy drugs

• different combinations of these cancer drugs with other treatments

When you go home

Treatment with immunotherapy or targeted cancer drugs can be difficult to cope with for some people. Your nurse will give you a number to call (advice line) if you have any problems at home.