Dr. Rule on the Future Therapeutic Landscape of MCL

Simon Rule, MD, professor of hematology, University of Plymouth, discusses the future therapeutic landscape of mantle cell lymphoma (MCL).

Recognition of high-dose cytarabine and the addition of rituximab (Rituxan) to chemotherapy as staples of treatment have been 2 of the main advances made in MCL, says Rule. Learning that rituximab can be of benefit in the maintenance setting was another key development.

However, with the advent of BTK inhibitors, the field is going to become less reliant on chemotherapy, he says. Several trials are evaluating chemotherapy-free regimens. Notably, a trial in the United Kingdom is evaluating the combination of rituximab and ibrutinib (Imbruvica) in comparison with rituximab and chemotherapy in this patient population. The trial will determine whether frontline chemotherapy is necessary in an elderly patient population, explains Rule.

Ibrutinib has shown high responses as a single agent, so the next logical step will be to evaluate the agent in combination with other potent drugs, such as venetoclax (Venclexta). Minimal residual disease may also come into play after induction to determine whether additional therapy is warranted or whether treatment can be discontinued, concludes Rule.