Simon Rule, MD, PhD

Simon Rule, MD, PhD, professor of hematology, University of Plymouth, shares his thoughts on the

FDA&rsquo;s decision to grant zanubrutinib, a BTK inhibitor, priority review for the treatment of patients with mantle cell lymphoma

(MCL). Should the drug be approved, it will be available for patients with MCL who have received at least 1 prior line of therapy.

Rule says he has used 5 BTK inhibitors now for patients with MCL, and they all work. These agents have had the same activity, in his opinion, but they have different toxicity profiles. He is pleased to potentially have another BTK inhibitor become available in this space.

Although there is excitement around having a new drug entering this space, he thinks it is possible that there will be added pressure on pricing and making these drugs more widely available for patients with MCL. In the United Kingdom, acalabrutinib (Calquence) is not available yet for these patients, as it is in the United States, but with zanubrutinib coming down the pipeline, it can only be good for patients with MCL.

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Simon Rule, MD, PhD, shares his thoughts on the&nbsp;FDA&rsquo;s decision to grant zanubrutinib, a BTK inhibitor, priority review for the treatment of patients with mantle cell lymphoma. Should the drug be approved, it will be available for patients with MCL who have received at least 1 prior line of therapy.

Rule Discusses the Potential of Zanubrutinib in the Treatment of Mantle Cell Lymphoma

Simon Rule, MD, PhD, a professor of clinical hematology on the faculty of medicine and dentistry at the University of Plymouth in the United Kingdom, discusses the current treatment approaches for patients with mantle cell lymphoma (MCL) in both the United Kingdom and the United States. He says treatment strategies are pretty well established on both sides of the Atlantic Ocean.

For young patients with MCL, the recommended frontline treatment is a high-dose cytarabine-based regimen followed by autologous stem cell transplant (SCT). Evidence for a rituximab (Rituxan) maintenance is also strong in this setting. Physicians should select their cytarabine regimen based on what they are comfortable with giving, says Rule.

For older patients over the age of 65 years old, Rule says the general standard of care is bendamustine- or CHOP-based regimen. Again, there is some evidence for debate in regard to a rituximab maintenance. Frail elderly patients, however, have no established standard of care.

For patients with relapsed disease, single-agent BTK inhibitors have become the standard of care. There is some discussion among physicians on the combination of BTK inhibitors plus rituximab in this setting, but generally, physicians are using ibrutinib (Imbruvica) as a single-agent. Rule says this is a highly active agent.

Simon Rule, MD, PhD, discusses the current treatment approaches for patients with mantle cell lymphoma in both the United Kingdom and the United States. He says treatment strategies are pretty well established on both sides of the Atlantic Ocean.

Sequencing Treatment Options in Mantle Cell Lymphoma

Simon Rule, MD, PhD, a professor of hematology at Plymouth University Medical School in the United Kingdom, shares his treatment considerations for select patients with mantle cell lymphoma (MCL).&nbsp;

Rule says that in patients who are young and asymptomatic, his recommended approach is to watch and wait. This approach does not disadvantage the patient, Rule says. He mentions 1 patient in his early 50s that remained untreated for MCL with nodal disease for 12 years.

mutation, his suggestion is to try a more aggressive strategy, as it will be hard to get them into remission. In these patients, neither autograft or ibrutinib (Imbruvica) will work, so an early allogeneic stem cell transplant may be a good option.

Simon Rule, MD, PhD, shares his treatment considerations for select patients with mantle cell lymphoma.

Simon Rule, MD, PhD | Authors

Articles

Rule Discusses the Potential of Zanubrutinib in the Treatment of Mantle Cell Lymphoma

Sequencing Treatment Options in Mantle Cell Lymphoma

Advice for Treating Patients With MCL