Kami Maddocks, MD

Kami J. Maddocks, MD, associate professor of clinical internal medicine, Division of Hematology, The Ohio State University Comprehensive Cancer Center–James, discusses the role of tafasitamab (Monjuvi) and lenalidomide (Revlimid) following the approval of this agent as treatment of patients with relapsed/refractory diffuse large B-cell lymphoma.

For patients who are ineligible for salvage chemotherapy followed by transplant, this combination was approved for the treatment of patients after first relapse. Historically, physicians would provide some sort of palliative chemotherapy in this setting if the patient was a candidate and was pursuing therapy or had consideration of clinical trial, but this is the only approved agent in this setting, Maddocks says.

The overall response rate in the phase 2 study that led to the combination’s approval was 60% with a complete response rate of 40%. The median progression-free survival was a little over 1 year, and the median overall survival was not reached in the initial dataset. With further follow-up, though, Maddocks says the median duration of response was nearly 3 years. This is an impressive finding, that patients achieve durable responses with the combination.

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Kami J. Maddocks, MD, discusses the role of tafasitamab and lenalidomide following the approval of this agent as treatment of patients with relapsed/refractory diffuse large B-cell lymphoma.

Tafasitamab Plus Lenalidomide Approval Generates Excitement for Second-Line DLBCL

Kami J. Maddocks, MD, associate professor of clinical internal medicine, Division of Hematology, The Ohio State University Comprehensive Cancer Center–James, discusses the use of Bruton’s tyrosine kinase (BTK) inhibitors in patients with B-cell malignancies and how that may change in the future to provide more treatment options for these patients.

BTK inhibitors are currently used as single-agent therapies and are continued indefinitely if patients are tolerating treatment and having a good response. Some questions for this type of treatment include how well it would work as a frontline therapy and if combinations of BTK inhibitors could produce deeper remissions, according to Maddocks.

Maddocks says another question is whether treatments could allow for limited therapies. This means if a patient receives multiple drugs over the course of 2 to 3 years and they are able to achieve deep remissions or minimal residual disease negative remissions, will that patient be able to stop these therapies after a shorter amount of time instead of being on treatment indefinitely? The patient stopping therapy after a while helps decrease long-term toxicity and cost. A follow-up question is whether patients could be retreated with these therapies after stopping treatment and relapsing a few years down the line.

In mantle cell lymphoma, where BTK inhibitors are used in the relapsed setting, Maddocks asks whether it could be moved up to the frontline setting to improve outcomes in those patients.

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Kami J. Maddocks, MD, discusses the use of Bruton’s tyrosine kinase inhibitors in patients with B-cell malignancies and how that may change in the future to provide more treatment options for these patients.

Exploring Questions Remaining for BTK Inhibitors and B-Cell Malignancies

76-Year-Old-Woman With Stage IV Mantle Cell Lymphoma

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Case: A 76-Year-Old Woman with High Risk Mantle Cell Lymphoma

A 76-year-old woman presented with a 2-month history of occasional night sweats, intermittent fatigue and decreased appetite

PMH: DM, medically controlled; GERD controlled on OTC medication

PE: bilateral cervical lymphadenopathy, splenomegaly



LDH 405 U/I, ANC 3200/mm3, beta-2-microglobulin 4.1 µg/L, leukocytes, 5.42 X 109/L, hemoglobin 9.1 gm/dL

Immunocytochemistry: cyclin D1+, CD5+, CD20+, CD43+, CD10-, CD23-

Bone marrow biopsy positive for lymphoid cells with cyclin D1

PET/CT scan showed widespread lymphadenopathy including inguinal node (5.1 cm) and splenomegaly

Ann Arbor stage IV; MIPI score 6.4; ECOG PS 0



She was started on bendamustine + rituximab

At 18 months the patient had clinical disease relapse, including an unintentional 7-lb weight loss

She was started on ibrutinib 560 mg PO qDay

Imaging at 10-week follow-up showed substantial decrease in disease burden

Kami Maddocks, MD, reviews the case of a 76-year-old woman with stage 4 mantle cell lymphoma and evaluates the role of BTK inhibitors in the treatment of relapsed/refractory disease.

Author | Kami Maddocks, MD

Articles

Tafasitamab Plus Lenalidomide Approval Generates Excitement for Second-Line DLBCL

Exploring Questions Remaining for BTK Inhibitors and B-Cell Malignancies

A 76-Year-Old Woman With High Risk Mantle Cell Lymphoma