Andre Goy, MD

Andre Goy, MD, chief in the division of lymphoma, chairman and director at John Theurer Cancer Center, discusses the different BTK inhibitors as treatment of patients with relapsed/refractory mantle cell lymphoma.

What is interesting is this provides a new platform in the relapsed/refractory setting, says Goy. BTK inhibitors are inducing some durability of response. When looking at the long-term follow-up data for these agents, such as ibrutinib (Imbruvica), it is interesting to see that if a patient had 1 prior line of therapy, they had a very durable response with a median progression-free survival over 33 months compared with 8 months for 2 or more prior lines of therapy. They also saw that when a patient has a complete response, durability is over 5 years.

BTK inhibition has a bit of an inconvenience in terms of toxicity, particularly the off-target effects. Atrial fibrillation and risk of bleeding are higher with Ibrutinib compared with the other BTK inhibitors because they are more selective, particularly acalabrutinib (Calquence), says Goy. There is not much data for zanubrutinib (Brukinsa), but the same toxicity has been observed. However, Goy notes there was less atrial fibrillation and bleeding with zanubrutinib.

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Andre Goy, MD, discusses the different BTK inhibitors as treatment of patients with relapsed/refractory mantle cell lymphoma.

BTK Inhibitors Improve Responses Relapsed/Refractory Mantle Cell Lymphoma

Andre Goy, MD, chief of the Division of Lymphoma, and chairman and director of John Theurer Cancer Center at Hackensack University Medical Center, discusses the current treatments, specifically Bruton&rsquo;s tyrosine kinase (BTK), for patients with mantle cell lymphoma (MCL) and what the efficacy has been with this type of treatment.

Goy believes that the MCL setting has made a lot of progress over the past decade. There are now 6 agents approved for patients with MCL, 5 of which are in the United States. This includes 3 BTK inhibitors with ibrutinib (Imbruvica) being the first approval. Ibrutinib had a objective response rate (ORR) of about 60% and a complete response (CR) rate of about 20%, with CRs increasing over time and a median duration of response (DOR) around 17 months.

After that was the acalabrutinib (Calquence) approval. The drug had an ORR of about 80%, and half the patients had CRs. The median DOR was updated at about 27 months. Following this approval was zanubrutinib (Brukinsa), which was approved because of its high ORR in patients of around 84% and almost 60% CR rate; the DOR was around 19 months.

Goy thinks these drugs provide a new platform in the relapsed/refractory MCL setting. He says that there is more durability of response, and these novel therapies are creating an impact. Due to long-term follow-up with BTK inhibitors such as ibrutinib, which has had over 7 years of follow-up, investigators have seen a difference for patients who had received 1 line of prior of therapy when they entered the study versus patients with &ge;2 lines of prior therapy, with durable response and a median progression-free survival over 33 months versus 8 months, respectively. The CR rate is higher for the patients with less prior treatment, and when they have a CR, the durability is over 5 years.

<< View more on BTK inhibitors in MCL from this interview with Andre Goy, MD

Andre Goy, MD, discusses the current treatments, specifically Bruton&rsquo;s tyrosine kinase, for patients with mantle cell lymphoma and what the efficacy has been with this type of treatment.

BTK Inhibitors Demonstrate Efficacy in Mantle Cell Lymphoma

Andre Goy, MD, chief in the Division of Lymphoma, chairman and director at John Theurer (JT) Cancer Center, discusses the results from a small clinical trial, which was presented at the 2019 American Society of Hematology (ASH) Annual Meeting that he found particularly significant for the treatment of patients with relapsed/refractory mantle cell lymphoma (MCL).

Although it was a small study, Goy says the results from the combination of venetoclax (Venclexta) plus ibrutinib (Imbruvica), a biological combination, demonstrated an impressive complete response rate, as well as impressive minimal residual disease-negativity, in patients with relapsed/refractory MCL. However, what was most impressive with this combination was that some patients had to stop treatment for different reasons, but that a number of these patients remained in remission 18 months after treatment discontinuation.

It is unheard of that patients could continue to receive benefit from a biological combination after discontinuing treatment, Goy says. This demonstrates the potential to stop therapy in patients with relapsed/refractory MCL. Goy concludes that these findings may be critical in the treatment landscape of MCL.

Andre Goy, MD, discusses the results from a small clinical trial, which was presented at the 2019 American Society of Hematology Annual Meeting that he found particularly significant for the treatment of patients with relapsed/refractory mantle cell lymphoma.

Venetoclax Plus Ibrutinib Combo Shows Potential in Relapsed/Refractory MCL

Andre Goy, MD, chief in the division of lymphoma, chairman and director at John Theurer Cancer Center, discusses the role of rituximab (Rituxan) and bendamustine plus cytarabine (R-BAC) as a treatment for patients with mantle cell lymphoma (MCL).

Goy says the data with R-BAC are interesting because the agents are combined to get the best of both rituximab and bendamustine, with low-dose cytarabine for age and myelotoxicity. Outside of clinical trials, Goy says R-BAC is an appealing option because it offers a sustainable progression-free survival, duration of response, and a very high complete response rate.

Andre Goy, MD, discusses the role of rituximab and bendamustine plus cytarabine as a treatment for patients with mantle cell lymphoma.

Andre Goy, MD | Authors

Articles

BTK Inhibitors Improve Responses Relapsed/Refractory Mantle Cell Lymphoma

BTK Inhibitors Demonstrate Efficacy in Mantle Cell Lymphoma

Venetoclax Plus Ibrutinib Combo Shows Potential in Relapsed/Refractory MCL

Identifying the Role of R-BAC Maintenance in MCL