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Next Steps in MCL Include Frontline Trials of BTK Inhibitors

Brandon Scalea
Published: Tuesday, Sep 04, 2018

Simon Rule, MD
Simon Rule, MD, PhD
The promising activity BTK inhibitors have shown in patients with relapsed mantle cell lymphoma (MCL) has led to studies investigating these agents in the the frontline setting.

, Rule, professor of Hematology at Plymouth University Medical School, United Kingdom, discussed the current and potential use of BTK inhibitors for the treatment of patients with MCL.

OncLive: What is the typical prognosis for a patient with MCL, and what is the current standard of care?

Rule: The prognosis depends a little bit on whether you're looking at trial-related data or population-based data. The population-based data, of course, is a lot worse than the data we see in trials. The general prognosis is somewhere between 3 and 5 years. For the younger patients, it's clearly a lot better than that. It's a moving target because BTK inhibitors are going to make a huge difference, particularly in the relapsed setting. It is definitely improving, though.

For frailer patients, [this combination will be given] very early because they likely won't respond to what you give them in the frontline setting. There is a small group of patients where you actually don't want to treat their diagnosis, you want to just [observe]. It's an indolent group of patients; they are asymptomatic. You'll find that some of them will do reasonably well if they go untreated for a long period of time. Therefore, this is pretty much where we are today.

Is BTK inhibition being tested outside the relapsed setting?

The relapsed setting is where these agents are approved, so that's where we are confined right now. However, there are frontline trials going on. I'm involved with one in the United Kingdom where we are using ibrutinib plus rituximab versus chemotherapy. There are about 140 patients in that trial right now. There is also a frontline study testing bendamustine and rituximab in combination, with or without ibrutinib.

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