Owen O'Connor, MD, PhD, professor of medicine and experimental therapeutics, director of the Center for Lymphoid Malignancies, Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center, discusses treatment options following progression on ibrutinib (Imbruvica) for patients with mantle cell lymphoma (MCL).

It depends in what line of therapy the patient was receiving ibrutinib, the kinetics of their disease growth, and the symptoms associated with the disease. According to O’Connor, if lenalidomide (Revlimid) has not been used, that is a viable option since there has been success with that regimen.

In the study that led to the FDA approval of lenalidomide, patients received 25 mg for 3 out of 4 weeks. However, there is an additional study that is investigating lenalidomide in combination with rituximab (Rituxan) which used a lower dose of 20 mg without that break. This lower dose combination showed a high rate of complete responses and patients were able to achieve minimal residual disease (MRD) negativity with durable remissions beyond 4 years. Additionally, the combination has had less toxicity, says O’Connor.

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Dr. O'Connor on Treatment Options Following Ibrutinib Progression in MCL

Owen O'Connor, MD, PhD, professor of medicine and experimental therapeutics, director of the Center for Lymphoid Malignancies, Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center, discusses acalabrutinib (Calquence) versus ibrutinib (Imbruvica) for the treatment of patients with mantle cell lymphoma (MCL).

Acalabrutinib is seen to be a cleaner, more selective BTK inhibitor, says O’Connor. It hits fewer kinases than ibrutinib, which could mean better tolerability, he adds.

Owen O'Connor, MD, PhD, Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center, discusses acalabrutinib (Calquence) versus ibrutinib (Imbruvica) for the treatment of patients with mantle cell lymphoma

Dr. O'Connor on Acalabrutinib Versus Ibrutinib in MCL

Owen O'Connor, MD, PhD, professor of medicine and Experimental Therapeutics, director of the Center for Lymphoid Malignancies, Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center, discusses acalabrutinib (Calquence) in mantle cell lymphoma (MCL).

The label for acalabrutinib is for patients with relapsed or refractory MCL, and does not signify whether it should be used after failing initial therapy with ibrutinib (Imbruvica), says O’Connor. This means that sequencing remains unclear.

O’Connor says that the bigger question is whether treatment with one BTK inhibitor takes away the benefit from another.

Owen O'Connor, MD, PhD, discusses acalabrutinib (Calquence) in mantle cell lymphoma (MCL).
 

Dr. O'Connor Discusses Acalabrutinib in MCL

Owen O'Connor, MD, PhD, professor of medicine and Experimental Therapeutics, director of the Center for Lymphoid Malignancies, Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center, discusses the role of obinutuzumab (Gazyva) in the treatment of patients with follicular lymphoma.

Obinutuzumab is reported to have better antibody dependent cell-mediated cytotoxicity (ADCC) in comparison to rituximab (Rituxan), explains O'Connor. The GADOLIN study investigated patients with refractory follicular lymphoma, which is a population that does not have many treatment options available

The GADOLIN study compared obinutuzumab plus bendamustine followed by obinutuzumab maintenance versus bendamustine alone.

Owen O'Connor, MD, PhD

Articles

Dr. O'Connor on Treatment Options Following Ibrutinib Progression in MCL

Dr. O'Connor on Acalabrutinib Versus Ibrutinib in MCL

Dr. O'Connor Discusses Acalabrutinib in MCL

Dr. O'Connor on the Role of Obinutuzumab in Follicular Lymphoma