Classical Hodgkin lymphoma, stage III or IV - combination treatment with doxorubicin, vinblastine and dacarbazine (AVD)

Active Ingredient: Nivolumab

Indication for Nivolumab

Population group: only adolescents (12 years - 18 years old) , adults (18 years old or older)
Therapeutic intent: Curative procedure

Nivolumab in combination with doxorubicin, vinblastine and dacarbazine (AVD) is indicated for adults and adolescents 12 years of age and older with previously untreated Stage III or IV classical Hodgkin lymphoma.

For this indication, competent medicine agencies globally authorize below treatments:

For patients weighing ≥80 kg 240 mg every 2 weeks and for patients weighing <80 kg 3 mg/kg every 2 weeks

For:

Dosage regimens

Regimen A, in the case that patient weight is ≥ 80 kg :

Intravenous, 240 milligrams nivolumab, once every 2 weeks.

Regimen B, in the case that patient weight is < 80 kg :

Intravenous, 3 milligrams nivolumab per kilogram of body weight, once every 2 weeks.

Detailed description

Recommended doses and infusion times for intravenous administration of nivolumab in combination with AVD chemotherapy for previously untreated cHL:

  Combination phase for 6 dosing cycles*
NivolumabAdolescents (12 years of age and
older weighing at least
80 kg)
240 mg every 2 weeks over 30 minutes
NivolumabAdolescents (12 years of age and
older weighing less than 80 kg)
3 mg/kg every 2 weeks over 30 minutes
Doxorubicin,
vinblastine and
dacarbazine (AVD)
 Every 2 weeks

* One dosing cycle of nivolumab in combination with AVD is 28 days

Duration of treatment

Treatment with nivolumab should be continued as long as clinical benefit is observed or until treatment is no longer tolerated by the patient (and up to maximum duration of therapy if specified for an indication).

Atypical responses (i.e., an initial transient increase in tumour size or small new lesions within the first few months followed by tumour shrinkage) have been observed. It is recommended to continue treatment with nivolumab for clinically stable patients with initial evidence of disease progression until disease progression is confirmed.

Dose escalation or reduction is not recommended for nivolumab. Dosing delay or discontinuation may be required based on individual safety and tolerability.

Nivolumab should be permanently discontinued for:

  • Grade 4 or recurrent Grade 3 adverse reactions;
  • Persistent Grade 2 or 3 adverse reactions despite management.

If dosing is resumed after a delay, monotherapy could be resumed based on the evaluation of the individual patient.

When nivolumab is administered in combination with chemotherapy, refer to the SmPC of the other combination therapy agents regarding dosing. If any agents are withheld, the other agents may be continued. If dosing is resumed after a delay, chemotherapy alone could be resumed based on the evaluation of the individual patient.

240 mg every 2 weeks

For:

Dosage regimens

Intravenous, 240 milligrams nivolumab, once every 2 weeks.

Detailed description

Recommended doses and infusion times for intravenous administration of nivolumab in combination with AVD chemotherapy for previously untreated cHL:

  Combination phase for 6 dosing cycles*
NivolumabAdults240 mg every 2 weeks over 30 minutes
Doxorubicin,
vinblastine and
dacarbazine (AVD)
 Every 2 weeks

* One dosing cycle of nivolumab in combination with AVD is 28 days

Duration of treatment

Treatment with nivolumab should be continued as long as clinical benefit is observed or until treatment is no longer tolerated by the patient (and up to maximum duration of therapy if specified for an indication).

Atypical responses (i.e., an initial transient increase in tumour size or small new lesions within the first few months followed by tumour shrinkage) have been observed. It is recommended to continue treatment with nivolumab for clinically stable patients with initial evidence of disease progression until disease progression is confirmed.

Dose escalation or reduction is not recommended for nivolumab. Dosing delay or discontinuation may be required based on individual safety and tolerability.

Nivolumab should be permanently discontinued for:

  • Grade 4 or recurrent Grade 3 adverse reactions;
  • Persistent Grade 2 or 3 adverse reactions despite management.

If dosing is resumed after a delay, monotherapy could be resumed based on the evaluation of the individual patient.

When nivolumab is administered in combination with chemotherapy, refer to the SmPC of the other combination therapy agents regarding dosing. If any agents are withheld, the other agents may be continued. If dosing is resumed after a delay, chemotherapy alone could be resumed based on the evaluation of the individual patient.

Active ingredient

Nivolumab

Nivolumab is a human immunoglobulin G4 (IgG4) monoclonal antibody (HuMAb), which binds to the programmed death-1 (PD-1) receptor and blocks its interaction with PD-L1 and PD-L2. Nivolumab potentiates T-cell responses, including anti-tumour responses, through blockade of PD-1 binding to PD-L1 and PD-L2 ligands. In syngeneic mouse models, blocking PD-1 activity resulted in decreased tumour growth.

Read more about Nivolumab

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