Immunotherapy with drugs

The treatment of lymphomas has undergone a shift in the last few decades, from traditional cytotoxic chemotherapy toward immune-targeting agents that supplement or, in some cases, even supplant direct tumor killing with activation of antitumor systemic immunity. Since the introduction of the first known immunomodulatory modality, allogeneic hematopoietic cell transplantation, multiple immunotherapeutic approaches have been developed including monoclonal antibodies (mABs), antibody-drug conjugates, bispecific T-cell engagers, checkpoint inhibitors, small molecule inhibitors, chimeric antigen receptor (CAR) T-cell therapies, and vaccines. Many of these agents, either as monotherapies or as a component of a combination strategy, have shown impressive results, combining efficacy with tolerability. Immunotherapy ranging from mABs to checkpoint inhibitors and CAR T-cell therapy are now integrated into lymphoma treatment from the earliest lines of therapy to the relapsed and refractory setting for both Hodgkin (HL) and non-Hodgkin lymphoma (NHL). Although further studies are needed to improve our understanding of the unique side effects of immunomodulation, to determine the optimal sequence and combinations of these agent with targeted therapies and standard chemotherapy, and to identify predictive biomarkers, they clearly represent a growing list of treatment options for both HL and NHL and an important step on our road toward cure of these diseases.