Simon Rule, MD, PhD, professor of hematology, Plymouth University Medical School, United Kingdom, discusses the role of BTK inhibitors in the treatment of patients with mantle cell lymphoma (MCL).
The rise of the BTK inhibitors ibrutinib (Imbruvica) and acalabrutinib (Calquence) have made the biggest impact on this disease, Rule says. A big unanswered question is whether the younger patient population needs these agents in the frontline setting. Data show these patients typically do well with high-dose cytarabine-based chemotherapy and then are off drugs with a standard quality of life. In the relapsed setting is where novel therapies are usually introduced.
Rule says there is an ongoing trial in Europe looking at high-dose cytarabine with 3 arms: chemotherapy, followed by stem cell transplant and maintenance therapy, plus 2 experimental arms incorporating ibrutinib, and seeing whether transplant can be avoided. This trial will likely take years to meet its accrual goal, but it will eventually challenge the traditional paradigm involving stem cell transplant. Rule concludes that it’s important to not to forget that chemotherapy is effective.