Dr Dreyling on the Role of BTK Inhibitors in Frontline MCL

“Today, BTK inhibition is a mandatory part of first-line treatment [for patients with mantle cell lymphoma]. In younger, more fit patients we know that it improves overall survival by [approximately] 10% after 4 years of treatment, which is a major shift [in the treatment paradigm].”

Martin Dreyling, MD, PhD, a full professor in the Department of Medicine and head of the Medical Clinic III at University Hospital/Ludwig-Maximilians-University Munich, discussed the role of BTK inhibitors for the frontline treatment of patients with mantle cell lymphoma (MCL).

BTK inhibition is a mandatory component of first-line treatment for patients with MCL, Dreyling began. Treatment with these agents improves overall survival in younger, more fit patients by approximately 10% following 4 years of treatment, he continued. In light of data from the phase 3 ECHO trial (NCT02972840), the BTK inhibitor ibrutinib (Imbruvica) can be used in combination with bendamustine and rituximab (Rituxan) can also be used in certain patient subgroups, he added.

For the treatment of older patients or young patients with significant comorbidities, ibrutinib in combination with rituximab represents a viable treatment option, Dreyling explained. For most younger patients, autologous stem-cell transplantation (ASCT) is now withheld, which means that the regimen of ibrutinib plus chemoimmunotherapy studied in the phase 3 TRIANGLE study (NCT02858258) is now feasible for the treatment of patients up to approximately 75 years old, he noted. However, the best treatment option for intermediate-aged patients remains an open question, he said.

In intermediate-age patients with a Ki-67 score of approximately 50%, Dreyling noted that he would lean towards using the TRIANGLE regimen. If a TP53 mutation is present without a great deal of disease proliferation, Dreyling would prefer to use the ECHO regimen, he indicated.