Andre H. Goy, MD, physician in chief, Hackensack Meridian Health Oncology Care Transformation Service, chairman and chief physician officer, John Theurer Cancer Center, Lydia Pfund Chair for Lymphoma, academic chairman oncology, Hackensack Meridian School of Medicine at Seton Hall University, and professor of medicine, Georgetown University, discusses the potential utility of BTK inhibitors as maintenance therapy in mantle cell lymphoma (MCL).

Though the data is early, BTK inhibitors appear to have activity as maintenance therapy in MCL, explains Goy.

A study from the European MCL Intergroup is evaluating ibrutinib (Imbruvica) as maintenance therapy in patients who had an autologous stem cell transplant after rituximab (Rituxan), with cyclophosphamide, doxorubicin, vincristine, and prednisone, R-BAC (rituximab, bendamustine, and cytarabine), and transplant induction, concludes Goy.

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Andre H. Goy, MD, discusses the potential utility of BTK inhibitors as maintenance therapy in mantle cell lymphoma.

Dr. Goy on the Potential Utility of BTK Inhibitors as Maintenance in MCL

Andre H. Goy, MD, MS, chief, Division of Lymphoma, chairman and director, John Theurer Cancer Center, discusses the utility of novel agents in mantle cell lymphoma (MCL).

At the 2019 ASH Annual Meeting, a European group presented data regarding the combination of venetoclax (Venclexta), ibrutinib (Imbruvica), and obinutuzumab (Gazyva) in patients with newly diagnosed MCL. The regimen showed promising signals of efficacy and tolerability, even among patients with high-risk features. Further follow-up may demonstrate the utility of novel agents in patients with high-risk disease, says Goy.

In terms of established frontline regimens, the combination of rituximab (Rituxan) and ibrutinib has shown widespread utility in MCL. Now, investigators are evaluating the combination paired with agents such as venetoclax and lenalidomide (Revlimid); this may become a key part of future management strategies, says Goy. Most notably, CAR T-cell therapy has shown encouraging efficacy in the relapsed/refractory setting, concludes Goy.

Dr. Goy on the Utility of Novel Agents in MCL

Andre H. Goy, MD, MS, chief, Division of Lymphoma, chairman and director, John Theurer Cancer Center, discusses preliminary data with the combination of ibrutinib (Imbruvica) and venetoclax (Venclexta) in relapsed/refractory mantle cell lymphoma (MCL).

BTK inhibitors have changed the paradigm of relapsed/refractory MCL, says Goy. This year, zanubrutinib (Brukinsa) became the third BTK inhibitor to receive regulatory approval for the treatment of adult patients with MCL who have received at least 1 prior therapy.

Now, the field is investigating novel combinations with BTK inhibitors. For example, at the 2019 ASH Annual Meeting, 3-year follow-up data from the phase II AIM trial were presented. Results showed that the rate of minimal residual disease (MRD) negativity was 67%. Prior data showed that the 16-week complete remission (CR) rate was 62%. After a median follow-up of 18.5 months, 5 patients who achieved an MRD-negative PET-confirmed CR interrupted treatment. One patient developed progressive disease after 7 months, and the other 4 remained free of clinical or MRD progression after 6, 13, 17, and 18 months off therapy.

Such responses are unprecedented in MCL and could represent the potential for fixed-duration therapy, concludes Goy.

Andre H. Goy, MD, MS

Articles

Dr. Goy on the Potential Utility of BTK Inhibitors as Maintenance in MCL

Dr. Goy on the Utility of Novel Agents in MCL

Dr. Goy on Preliminary Data With Ibrutinib/Venetoclax in Relapsed/Refractory MCL