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Commentary|Videos|October 15, 2025

Dr Dreyling on Prior Findings From the ECHO Trial of Acalabrutinib Plus BR in Pretreated MCL

Author(s)Martin Dreyling, MD

Fact checked by: Jax DiEugenio, Courtney Flaherty

Martin Dreyling, MD, discusses prior findings and potential implications of the phase 3 ECHO trial of acalabrutinib plus BR in pretreated MCL.

Episodes in this series

EP. 1 Dr Dreyling on the Expanding Role of BTK Inhibitors in the Treatment of MCL

EP. 1 Dr Dreyling on the Expanding Role of BTK Inhibitors in the Treatment of MCL

Martin Dreyling, MD, full professor, Department of Medicine, University Hospital, head, Medical Clinic III, Ludwig-Maximilian University Munich

EP. 2 Dr Dreyling on Investigating ASCT Plus Ibrutinib and R-CHOP in Younger, Fit Patients With MCL

Martin Dreyling, MD, PhD, full professor, Department of Medicine, head, Medical Clinic III, University Hospital/Ludwig-Maximilians-University Munich

EP. 3 Dr Dreyling on the Efficacy of Frontline Acalabrutinib Plus BR in High-Risk MCL

Martin Dreyling, MD, PhD, University Hospital/Ludwig-Maximilians-University Munich

EP. 4 Dr Dreyling on the Role of BTK Inhibitors in Frontline MCL

Martin Dreyling, MD, PhD, University Hospital/Ludwig-Maximilians-University Munich

EP. 5 Dr Dreyling on the Rationale for Adding Acalabrutinib to BR in High-Risk MCL

Martin Dreyling, MD, PhD, University Hospital/Ludwig-Maximilians-University Munich

EP. 6 Dr Dreyling on Prior Findings From the ECHO Trial of Acalabrutinib Plus BR in Pretreated MCL

Martin Dreyling, MD, PhD, University Hospital/Ludwig-Maximilians-University Munich

EP. 7 Dr Dreyling on the Recommended Use of Acalabrutinib Plus BR in Pretreated MCL

Martin Dreyling, MD, PhD, University Hospital/Ludwig-Maximilians-University Munich

EP. 8 Dr Dreyling on the Evolving Role of BTK Inhibitors in MCL Management

"This study has the potential to show a similar [OS] benefit as we saw in the TRIANGLE trial, essentially opening the door to apply chemotherapy plus a BTK inhibitor for most patients [with MCL]..."

Martin Dreyling, MD, full professor, Department of Medicine, University Hospital LMU Munich, detailed previously reported findings from the phase 3 ECHO trial (NCT02972840), and the potential for updated data to show an overall survival (OS) benefit with acalabrutinib (Calquence) plus bendamustine plus rituximab (Rituxan; BR) in previously untreated, high-risk mantle cell lymphoma (MCL)

In January 2025, the FDA approved acalabrutinib plus BR for the treatment of adult patients with previously untreated MCL who are ineligible for autologous hematopoietic stem cell transplantation, based on prior data from ECHO.

These data showed that in the overall patient population, the addition acalabrutinib to BR resulted in a significant progression-free survival (PFS) benefit and a trend toward an overall survival (OS) benefit.

Dreyling noted that the trial faced the unique challenge of being conducted during the COVID-19 pandemic. As a result, a predefined protocol was utilized to censor for COVID-19 effects during analysis. When applying this censoring protocol, the observed difference in OS between the two arms became borderline statistically significant, he stated. Dreyling added that extended follow-up data are still anticipated to fully assess the OS benefit.

The potential significance of these results lies in their applicability to the main demographic affected by MCL: patients typically aged 65 to 75 years. Dreyling asserted that the ECHO study has the capability of demonstrating an OS benefit comparable to that previously observed in the phase 3 TRIANGLE (NCT02858258). If confirmed with longer follow-up, this would essentially validate the approach of combining chemotherapy with a BTK inhibitor, making this strategy accessible to the majority of patients with MCL.

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