Nivolumab Plus AVD for Hodgkin Lymphoma

  • In March 2026, the Food and Drug Administration (FDA) approved nivolumab in combination with doxorubicin, vinblastine, and dacarbazine (AVD) for previously untreated stage III or IV classical Hodgkin lymphoma.
  • This decision establishes a new frontline standard for advanced-stage disease.
  • The SWOG S1826 trial, a large, randomized phase III study comparing nivolumab-AVD with brentuximab vedotin plus AVD in advanced-stage cHL, demonstrated a significant improvement in progression-free survival with nivolumab-AVD, alongside a favorable safety profile.

On March 20, 2026, the Food and Drug Administration (FDA) approved nivolumab in combination with doxorubicin, vinblastine, and dacarbazine (AVD) for previously untreated stage III or IV classical Hodgkin lymphoma. This decision establishes a new frontline standard for advanced-stage disease.

In addition to the frontline approval, nivolumab received traditional approval for two previously accelerated indications in adults with relapsed or refractory cHL following autologous hematopoietic stem cell transplantation (HSCT) and brentuximab vedotin, and after three or more lines of systemic therapy, including autologous HSCT.

These indications were initially granted accelerated approval in 2016 and 2017 and are now supported by confirmatory evidence. The nivolumab-AVD regimen has already been widely adopted in clinical practice over the past year for newly diagnosed advanced-stage cHL, reflecting strong clinician confidence in the emerging data.

“We had already incorporated nivolumab-AVD into frontline treatment for advanced-stage classical Hodgkin lymphoma based on the strength of the SWOG S1826 data,” Dr. Leslie Poppelwell, Chief of Hematology at City of Hope, tells SurvivorNet Connect. Its use remains focused on stage III/IV disease, she adds, consistent with the trial population and current guideline recommendations.

Improved PFS & Safety Profile

The SWOG S1826 trial, a large, randomized phase III study comparing nivolumab-AVD with brentuximab vedotin plus AVD in advanced-stage cHL, demonstrated a significant improvement in progression-free survival with nivolumab-AVD, alongside a favorable safety profile.

After extending the follow-up period to a median of 2.1 years, the research showed:

  • 2-year PFS was 92% in the nivolumab-AVD group
  • 2-year PFS was 83% in the brentuximab vedotin-AVD group
  • Nivolumab-AVD was associated with lower rates of peripheral neuropathy and treatment discontinuation

The pivotal research, published in the New England Journal of Medicine, underpins the current NCCN Category 1 recommendation for nivolumab-AVD in advanced-stage disease. The regimen is now considered a preferred option for patients with newly diagnosed stage III or IV classical Hodgkin lymphoma, offering improved disease control compared with prior standards, elimination of bleomycin-associated pulmonary toxicity, and reduced neuropathy relative to brentuximab vedotin-containing regimens.

The FDA approval of nivolumab in combination with AVD marks a significant shift in the treatment of advanced classical Hodgkin lymphoma. Supported by robust phase III data and rapid integration into clinical practice, nivolumab-AVD represents a new standard of care for frontline management in stage III/IV disease.

Natalie Rafaeli, MD is a specialist in malignant hematology, specifically with expertise in treating blood cancer. Dr. Rafaeli serves as an Assistant Professor in the McGovern Medical School Department of Internal Medicine. Her research focuses on developing novel treatment strategies. Dr. Rafaeli is board certified in Internal Medicine, Hematology, and Medical Oncology.

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