Inside the Clinic: Experts Highlight Molecular Complexities in MCL

Maher Albitar, MD, founder, chief executive officer, chief medical officer of Genomic Testing Cooperative, and Andre H. Goy, MD, physician in chief of the Hackensack Meridian Health Oncology Care Transformation Services, chairman and chief physician officer at John Theurer Cancer Center at Hackensack University Medical Center, and Lymphoma Division Chief at John Theurer Cancer Center, share insights regarding molecular complexities in mantle cell lymphoma (MCL).

Many patients with MCL who are not ideal candidates for standard therapies like chemotherapy or chemoimmunotherapy need refined treatment options that best fit their unique gene expression and disease profile, Goy says. Molecular abnormalities provide crucial information about patients that can be used to monitor their mutations, as well as detect minimal residual disease (MRD) and early relapse, Albitar adds.

In their discussion, Albitar and Goy share a case study of a 55-year-old patient with indolent MCL with gastrointestinal involvement whose symptoms progressed over 8 years of observation. This patient exhibited several structural and chromosomal abnormalities typical of evolving MCL that made them a poor candidate for chemoimmunotherapy, Goy explains. Instead of standard therapy, this patient was given rituximab (Rituxan) plus a BTK inhibitor for 3 months and became MRD negative. This is a prime example of the need to use liquid biopsy to explore potential inherited abnormalities to provide the best treatment and follow-up, Albitar continues.

Conducting next-generation sequencing (NGS) also provides a diagnostic advantage when investigating treatment methods for patients with MCL, as it allows for knowledge of somatic landscapes based on regional abnormalities, Goy says. NGS detects multiple genes at once and can indicate which subclone is going to emerge as more aggressive so therapy can be adjusted accordingly, Albitar concludes.