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BTK Inhibitors Demonstrate Efficacy in Mantle Cell Lymphoma

Andre Goy, MD
Published Online:7:18 PM, Wed March 18, 2020

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’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 ≥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.

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