Ann S. LaCasce, MD, MMSc, director of Dana-Farber/Partners CancerCare Hematology-Medical Oncology Fellowship Program, institute physician, Dana-Farber Cancer Institute, and associate professor of medicine, Harvard Medical School, discusses the FDA approval of lenalidomide (Revlimid) and rituximab (Rituxan; R

 regimen of lenalidomide plus rituximab for use in patients with previously treated follicular lymphoma and marginal zone lymphoma (MZL). In the double-blind, phase III AUGMENT trial, patients with relapsed/refractory follicular lymphoma or MZL were randomized to receive either rituximab plus lenalidomide or rituximab alone. Across the study, 295 patients had follicular lymphoma and 63 patients had MZL. Patient had to have received at least 1 prior chemotherapy, immunotherapy, or chemoimmunotherapy regimen, and could not be rituximab-refractory.

Overall survival (OS) data across the entire population showed that at a median follow-up of 28.3 months, the hazard ratio for OS was 0.61 (95% CI, 0.33-1.13). Furthermore, the 2-year OS rate was 93% (95% CI, 87-96) for R

 and 87% (95% CI, 81-92) for rituximab alone. The combination will be an effective regimen for patients who relapse early, says LaCasce, and the toxicities of lenalidomide can be easily mitigated.

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Ann S. LaCasce, MD, MMSc, director of Dana-Farber/Partners CancerCare Hematology-Medical Oncology Fellowship Program, institute physician, Dana-Farber Cancer Institute, and associate professor of medicine, Harvard Medical School, discusses the FDA approval of lenalidomide (Revlimid) and rituximab (Rituxan; R2) in non-Hodgkin lymphoma.

Dr. LaCasce Discusses the FDA Approval of Lenalidomide/Rituximab in Non-Hodgkin Lymphoma

Ann S. LaCasce, MD, MMSc, director of Dana-Farber/Partners CancerCare Hematology-Medical Oncology Fellowship Program, institute physician, Dana-Farber Cancer Institute, and associate professor of medicine, Harvard Medical School, discusses the future of mantle cell lymphoma (MCL) treatment.

The biggest challenge that currently exists in the paradigm is the blastoid variant patient population, says LaCasce. Patients who harbor 

 mutations tend to have a very aggressive disease. Once patients on ibrutinib (Imbruvica) discontinue therapy, their disease can accelerate very rapidly. Moreover, patients with 

 mutations most likely don’t benefit from autologous stem cell transplant, so there needs to be better options for this subset.

Moreover, the field of MCL needs more curative options, LaCasce adds. This could include CAR T-cell therapy, which has shown dramatic benefit in other hematologic malignancies. Most patients will likely fail stem cell transplant at some point, so having more trials, more novel immunotherapy treatments, combinations of CAR T-cell therapies, and other approaches are where the field should shift, states LaCasce.

Ann S. LaCasce, MD, MMSc, director of Dana-Farber/Partners CancerCare Hematology-Medical Oncology Fellowship Program, institute physician, Dana-Farber Cancer Institute, and associate professor of medicine, Harvard Medical School, discusses the future of mantle cell lymphoma treatment.

Dr. LaCasce Discusses the Future of MCL Treatment

Ann S. LaCasce, MD, MMSc, director of Dana-Farber/Partners CancerCare Hematology-Medical Oncology Fellowship Program, institute physician, Dana-Farber Cancer Institute, and associate professor of medicine, Harvard Medical School, discusses key advances made in the mantle cell lymphoma (MCL) paradigm.

There has been a lot of headway made in MCL, even prior to the use of novel agents with more intensified induction regimens followed by autologous transplant in younger patients, says LaCasce. Regarding the novel agents, ibrutinib (Imbruvica) is a very active drug, as is acalabrutinib (Calquence). Acalabrutinib is often used in the setting of first relapse because it is slightly better tolerated than ibrutinib with very similar efficacy. Moreover, there is venetoclax (Venclexta), which is also well tolerated with the exception of the risk of tumor lysis. However, this adverse event can be managed if treated appropriately.

The directive in terms of research is not as clear, explains LaCasce, although there is a lot to be explored. For example, one question to address is whether the combination of these drugs in addition to an antibody can result in minimal residual disease negativity. Another research focus is determining whether CAR T cells can be used a bridge to other therapy. Although there is a lot left to discern, there is no doubt that the field is better equipped to deal with relapse in the second-line setting and beyond, concludes LaCasce.

Ann S. LaCasce, MD, MMSc

Articles

Dr. LaCasce Discusses the FDA Approval of Lenalidomide/Rituximab in Non-Hodgkin Lymphoma

Dr. LaCasce Discusses the Future of MCL Treatment

Dr. LaCasce on Key Advances in the MCL Paradigm