Lori A. Leslie, MD, lymphoma attending, John Theurer Cancer Center, discusses a retrospective analysis of real-world patients with chronic lymphocytic leukemia (CLL) who were treated with acalabrutinib (Calquence).

Acalabrutinib is a next-generation BTK inhibitor that is thought to have less toxicity than the first-generation agent ibrutinib (Imbruvica). In the analysis, investigators evaluated patients who received acalabrutinib due to ibrutinib intolerance, says Leslie.

The results showed that the discontinuation rate in patients who received acalabrutinib was low, suggesting that the agent is a well-tolerated alternative for patients who stand to benefit from the BTK inhibitor. The impact of real-world data is becoming more apparent in oncology, especially in a chronic disease such as CLL where comparative studies take time to mature, concludes Leslie.

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Lori A. Leslie, MD, discusses a retrospective analysis of real-world patients with chronic lymphocytic leukemia who were treated with acalabrutinib (Calquence).

Dr. Leslie on Real-World Outcomes of Patients With CLL Treated With Acalabrutinib

Lori A. Leslie, MD, lymphoma attending, John Theurer Cancer Center, discusses advancements in mantle cell lymphoma (MCL).

There are a number of clinical trials currently ongoing in MCL. Challenges remain with certain subgroups, Leslie says, particularly patients who have

 abnormalities, and older patients who cannot tolerate intensive upfront therapy or transplant.

Leslie says that this is a great opportunity for chimeric antigen receptor (CAR) T-cell therapy to have a role in MCL treatment, as it has shown promising efficacy in heavily pretreated patients with diffuse large B-cell lymphoma. The ongoing ZUMA-2 trial is investigating the use of the anti-CD19 CAR T-cell product axicabtagene ciloleucel (axi-cel; Yescarta) in patients with relapsed/refractory MCL. Axi-cel is currently approved for select patients with non-Hodgkin lymphoma. That approval was based on the objective response rate from the phase II portion of the ZUMA-1 study.

Additionally, an important area of research is individualizing maintenance or consolidation therapy for patients who remain minimal residual disease-positive after induction therapy, Leslie says.

Lori A. Leslie, MD, lymphoma attending, John Theurer Cancer Center, discusses advancements in mantle cell lymphoma.
 

Dr. Leslie Discusses Advancements in Mantle Cell Lymphoma

Lori A. Leslie, MD, lymphoma attending, John Theurer Cancer Center, discusses the role of duvelisib in the treatment of patients with follicular lymphoma.

PI3K is an important target in follicular lymphoma, and duvelisib has shown efficacy in the relapsed/refractory setting. However, it is not without toxicity, Leslie says. Duvelisib and some of the other targeted agents, though effective, have a similar toxicity profile. Some newer agents approved in the relapsed/refractory setting, like copanlisib (Aliqopa), have a similar efficacy without the added toxicity of some of the previous generation PI3K inhibitors.

Umbralisib (TGR-1202) is another efficacious and tolerable PI3K-delta inhibitor that likely will be approved for follicular lymphoma, Leslie explains. Developing better prognostic indices to predict poor outcomes to upfront chemoimmunotherapy will help physicians better use risk-adapted approaches to combine novel agents with standard-of-care backbones. Hopefully, the field will be able to move towards a chemotherapy-free approach, Leslie says.

Lori A. Leslie, MD, lymphoma attending, John Theurer Cancer Center, discusses the role of duvelisib (IPI-145) in the treatment of patients with follicular lymphoma.

Dr. Leslie Discusses Duvelisib in Follicular Lymphoma

Lori A. Leslie, MD, lymphoma attending, John Theurer Cancer Center, discusses the developing role of chimeric antigen receptor (CAR) T-cell therapy for patients with mantle cell lymphoma (MCL).

CAR T-cell therapy is an exciting advancement across lymphoma subtypes, with recently approved constructs in the diffuse large B-cell lymphoma subtype (DLBCL), says Leslie. There are ongoing trials in MCL that show promising efficacy in heavily pretreated patients.

In terms of patients with indolent lymphoma, CAR T-cell therapy is interesting because patients get too sick before they are able to receive the infusion of cells. Although the data are limited, there are excellent results, and patients can stay well enough to receive treatment. Hopefully this can be a curative treatment for this group of patients, Leslie adds.

Dr. Leslie Discusses CAR T-Cell Therapy in MCL

Lori A. Leslie, MD, lymphoma attending, John Theurer Cancer Center, discusses trial updates for patients with follicular lymphoma in the maintenance setting, which were presented at the 2017 ASH Annual Meeting.

The 10-year follow up of PRIMA, the randomized study looking at 2 years of maintenance rituximab (Rituxan) versus observation post-upfront immunochemotherapy, reported a greater than 50% progression-free survival (PFS) in the maintenance arm versus 35% in the observation arm.

An ad hoc analysis from the BRIGHT study looked at patients who received maintenance rituximab at the investigator’s discretion post bendamustine and rituximab, or R-CHOP/R-CVP therapy. There was a significant PFS benefit with maintenance rituximab compared with observation alone, but no overall survival benefit.

The BIONIC study looked at the use of bortezomib (Velcade) in the induction setting with or without the addition of lenalidomide (Revlimid) in the maintenance setting. This showed no increase in efficacy, but increased toxicity with the addition of these agents.

Lori A. Leslie, MD

Articles

Dr. Leslie on Real-World Outcomes of Patients With CLL Treated With Acalabrutinib

Dr. Leslie Discusses Advancements in Mantle Cell Lymphoma

Dr. Leslie Discusses Duvelisib in Follicular Lymphoma

Dr. Leslie Discusses CAR T-Cell Therapy in MCL

Dr. Leslie Discusses 2017 ASH Annual Meeting Updates