For patients who are younger and can undergo a more intensive transplant or dose-intensive strategies, there is a still a way to give them a progression-free survival that is well in excess of 5 to 7 years. If you look at the long-term follow-up, over 50% of these patients can do well over 10 years. There is clearly a fraction who have much better outcomes than just standard R-CHOP or bendamustine and rituximab (Rituxan)-type chemotherapy.
Given the median age of diagnosis in the late 60s, the usual patient cannot undergo intensive therapy. Therefore, for those patients, allogeneic transplant and CAR T-cell therapy might be very important. Finally, for the rest of patients, novel therapies will provide the option to either combine with chemotherapy or replace it.
Overall, the theme moving forward will be to gain a better understanding of the subset of MCL at baseline, bring them into complete remission early on, look at MRD status—because that is what affects the outcome—and potentially develop consolidation and maintenance based on MRD. That is basically the next 5 years in MCL.
You mentioned a database and patient characteristics. Do you see a place for Cota in this scenario?
The field of medicine is changing dramatically, but there are issues of sustainability on how we fit in the bigger picture of the pharmacological environment given the cost of the drugs, duration of treatment, etc. It is important that we have evidence that we are bringing clinical benefit to patients. If you look at the options for patients with lung cancer, there are 79 new options for non–small cell lung cancer. How do you pick the best option and how do you develop precision medicine? I would argue that precision medicine forces us to understand what we do best for what we know already.
What we've developed with Cota is a platform to identify the key factors defined by experts at baseline, based on clinical and biological molecular markers. This allows us to compare apples with apples and see the outcomes of the patients. Our goals are to focus on the outcome, make smarter decisions, and optimize the treatment decision. We follow the longitudinal journey of a patient based on their classification. By capturing toxicity, dose intensity, quality of life, progression-free survival, and cost, it gives us a GPS of cancer. What is an important question is, “What will be the next sequence of care?”