Mantle Cell Lymphoma

Brian T. Hill, MD, PhD, director of Lymphoid Malignancies at the Cleveland Clinic, discusses current combinations being investigated for the treatment of patients with mantle cell lymphoma.

Based on data from the phase II JULIET study, tisagenlecleucel has received FDA approval for the treatment of adult patients with relapsed/refractory large B-cell lymphoma—including diffuse large B-cell lymphoma, high-grade B-cell lymphoma, and DLBCL arising from follicular lymphoma—after 2 or more lines of systemic therapy.

While relapsed/refractory mantle cell lymphoma (MCL) is considered an aggressive disease, new findings show patients may benefit from adding chimeric antigen receptor T-cell therapy to their treatment regimen. ZUMA-2, a currently ongoing trial, aims to understand the potential benefits with axicabtagene ciloleucel, an anti-CD19 CAR T-cell product, for patients with relapsed/refractory MCL.

Voxtalisib (XL765) monotherapy induced objective responses in 41.3% of patients with follicular lymphoma, but displayed minimal efficacy in patients with other lymphomas, according to results from a phase II trial of patients with relapsed or refractory lymphoma or chronic lymphocytic leukemia that were recently published in the Lancet Haematology.

Enrollment has been halted by the FDA on clinical trials of tazemetostat in patients with various solid tumors and hematologic malignancies, according to Epizyme, the manufacturer of the EZH2 inhibitor.

Selina Chen-Kiang, PhD, a professor of pathology and immunology at Weill Cornell Medical College, discusses the rationale of her phase I trial investigating the use of CDK4/6 inhibitors for the treatment of patients with mantle cell lymphoma.

The B-Cell Lymphoma Moon Shot Program at The University of Texas MD Anderson Cancer Center wants to increase the cure rate of the disease from 30% to 60% within 5 years. In a presentation at the <em>22nd Annual</em> International Congress on Hematologic Malignancies, Michael Wang, MD, detailed results from 3 clinical trials that may help make that 5-year goal into a reality for patients with mantle cell lymphoma.

The field of mantle cell lymphoma underwent a significant change with the FDA approval of ibrutinib in 2013. Now, the recent approval of&nbsp;acalabrutinib has similarly impacted the treatment landscape, as experts say it could be associated with slightly fewer adverse events than ibrutinib, according to Andre Goy, MD.

There was a 16-week complete response rate of 42% per CT imaging with the combination of venetoclax (Venclexta) and ibrutinib (Imbruvica) in patients with previously untreated or relapsed/refractory mantle cell lymphoma, according to results from the phase II AIM study.

Several new indications were approved by the FDA in March, including blinatumomab (Blincyto)&nbsp;for MRD+ ALL, brentuximab vedotin (Adcetris) for Hodgkin lymphoma, and a 4-week nivolumab (Opdivo) dosing schedule across several indications. Here&rsquo;s a look back on the FDA happenings for the month of March 2018.

Michael L. Wang, MD, explains the&nbsp;biologic underpinnings of MCL as well as the treatment options for patients with MCL. The discussion is based on&nbsp;a case scenario of a patient with stage III intermediate-risk disease, and the factors that Wang would use when choosing the best treatment regimen for this patient.

Ibrutinib continues to be the standard of care for the treatment of relapsed/refractory patients with mantle cell lymphoma since its FDA approval in 2013, and long-term follow-up data of the Bruton&#39;s tyrosine kinase (BTK) inhibitor continue to demonstrate its clinical activity. In this interview with Targeted Oncology, an expert in the field sheds light on the impact of BTK inhibition on the treatment landscape.<br /> &nbsp;

The potential synergy of new agents with other treatment strategies, including immunotherapeutic and targeted approaches, is currently being investigated in various clinical trials, with the hope of identifying combinations that will lead to longer responses and improvements in duration of response for patients with MCL.

Effective management of mantle cell lymphoma requires awareness of current therapeutic approaches for a wide range of patient populations, clinical trials supporting the use of therapy in the frontline or relapsed/refractory settings, newer therapeutic options and strategies, and emerging therapies to improve patient outcomes&#8203;&#8203;&#8203;&#8203;&#8203;&#8203;.

Due to the diversity of disease presentation, together with new iterations of guidelines for MCL diagnosis, staging, and risk, there is no standardized therapeutic approach. Treatment decisions are currently guided by several factors, including patient age, level of fitness, presence of symptoms, risk category, proliferative index, and cell variant, which means&nbsp;it is important to accurately diagnose, stage, and assess risk in patients with MCL

Brad S. Kahl, MD,&nbsp;discusses the latest data for ibrutinib and highlighted emerging treatments in MCL.<br /> &nbsp;

According to phase I findings published in <em>The Lancet Oncology,</em>&nbsp;an&nbsp;objective response rate of 37% was induced in patients with&nbsp;relapsed/refractory lymphoma or chronic lymphocytic leukemia treated with the&nbsp;PI3K-delta inhibitor umbralisib.

Treatment with the&nbsp;CD19-targeted chimeric antigen receptor T-cell therapy lisocabtagene maraleucel (liso-cel, formally known as JCAR017) demonstrated&nbsp;a complete response rate of 63% and an&nbsp;objective response rate of 81%&nbsp;in patients with&nbsp;relapsed/refractory diffuse large B-cell lymphoma.

Peter Martin, MD,&nbsp;reflects on the MCL data presented at the 2017 ASH Annual Meeting, and shared his insight on the future of clinical trials in the disease.

Brian T. Hill, MD, PhD,&nbsp;shares more insight on acalabrutinib and ibrutinib&rsquo;s efficacy in patients with MCL and highlights emerging novel strategies in the treatment landscape.

Lymphoma expert Andrew M. Evens, DO, MSc, FACP, has joined Rutgers Cancer Institute of New Jersey as associate director. He is also serving as medical director of the oncology service line at RWJBarnabas Health. Evens will focus on integrated cancer care delivery in his roles across both institutions.

Peter Martin, MD, discusses a phase I, open-label, multicenter trial of oral azacitidine (Vidaza) plus R-CHOP in people with high-risk, previously untreated DLBCL, grade 3B follicular lymphoma, or transformed lymphoma.

Mitchell R. Smith, MD, PhD, recently shared both the more and less intensive treatment considerations he makes when treating patients with MCL and the major factors that influence them. Smith explained such considerations based on 2 case scenarios during a <em>Targeted Oncology</em> live case-based peer perspectives presentation.

Narendranath Epperla, MD,&nbsp;discusses the phase III GALLIUM trial, and the evolving treatment landscape for patients with follicular lymphoma and mantle cell lymphoma.

Michael Wang, MD,&nbsp;discusses the impact of acalabrutinib on patients with MCL, ongoing progress in the field, and The University of Texas MD Anderson Cancer Center&rsquo;s Lymphoma Moonshot Program.