Dr. Goy on the Evolution of Treatment Selection in MCL

Andre Goy, MD, MS, physician in chief, Hackensack Meridian Health Oncology Care Transformation Service; chairman & chief physician officer, John Theurer Cancer Center, Lydia Pfund Chair for Lymphoma; academic chairman, Oncology, Hackensack Meridian School of Medicine at Seton Hall University; professor of Medicine, Georgetown University, discusses the evolution of treatment selection in mantle cell lymphoma (MCL).

Significant changes have been happening in MCL, says Goy.People tend to think of MCL as a subset of very indolent disease. MCL has a different presentation, high white blood cell counts, splenomegaly, no lymphadenopathy, and a different gene expression profile, adds Goy. Patients with this disease are genetically stable and often harbor IGHV mutations, but they can be monitored for a long period of time.

With regard to treatment, the dichotomy has been to determine whether the patient can tolerate a high-dose therapy. It is arbitrary to consider age as a deciding factor, says Goy, aspatients are often 60 to 65 years old. Now, patients are routinely tested for p53 mutations via the use of next-generation sequencing, looking at NOTCH and other molecular factors.

Then, the challenge is trying to determine which patients have these molecular features because they typically do very poorly, particularly those with p53 mutations. Typically, the median survival for those patients is less than 1 year. These patients are treated with a combination of ibrutinib (Imbruvica) and rituximab (Rituxan), says Goy. Ongoing trials are looking at to confirm the efficacy of this approach. Then, younger patients are given a shorter course of chemotherapy afterward, concludes Goy.