Ann S. LaCasce, MD, MMSc, director of Dana-Farber/Partners CancerCare Hematology-Medical Oncology Fellowship Program, institute physician, Dana-Farber Cancer Institute, and associate professor of medicine, Harvard Medical School, discusses key advances made in the mantle cell lymphoma (MCL) paradigm.
There has been a lot of headway made in MCL, even prior to the use of novel agents with more intensified induction regimens followed by autologous transplant in younger patients, says LaCasce. Regarding the novel agents, ibrutinib (Imbruvica) is a very active drug, as is acalabrutinib (Calquence). Acalabrutinib is often used in the setting of first relapse because it is slightly better tolerated than ibrutinib with very similar efficacy. Moreover, there is venetoclax (Venclexta), which is also well tolerated with the exception of the risk of tumor lysis. However, this adverse event can be managed if treated appropriately.
The directive in terms of research is not as clear, explains LaCasce, although there is a lot to be explored. For example, one question to address is whether the combination of these drugs in addition to an antibody can result in minimal residual disease negativity. Another research focus is determining whether CAR T cells can be used a bridge to other therapy. Although there is a lot left to discern, there is no doubt that the field is better equipped to deal with relapse in the second-line setting and beyond, concludes LaCasce.