Changes in the MCL Treatment Landscape

Tycel Phillips, MD, discusses recent changes in the mantle cell lymphoma treatment landscape.

Tycel Phillips, MD, clinical associate professor, the Division of Hematology and Oncology, the Rogel Cancer Center, Michigan Medicine, University of Michigan Health, discusses recent changes in the mantle cell lymphoma (MCL) treatment landscape.

During a presentation at the National Comprehensive Cancer Network 2022 Annual Congress: Hematologic Malignancies, Tycel Phillips, MD, provided background on some of the effective treatment options currently available for patients with MCL.

He described each of the agents in depth, including their safety profiles, effectiveness, and explained the patients who would benefit most from each therapy.


0:08 | The needle shifted with the approval of the BTK [Bruton tyrosine kinase] inhibitors, which initially started with ibrutinib [Imbruvica]. The original paper from Michael Wong, MD, indicated progression-free survival of the group was around 13.9 months, which at that point was substantial in that patient population, and an overall response rate of around 60%. That shifted how we went about things. After, Simon Rule, MD, combined several ibrutinib studies indicating that the BTK inhibitor was far more effective in the second-line, and in the third-line setting. With patients who got a complete remission with ibrutinib in the second-line setting, the duration of response was almost 5 years. From that, it cemented that we should be using this agent in the second-line setting in an effort to get the longest remission possible for most of our patients.

1:02 | Thereafter, we had second generation BTK inhibitors, acalabrutinib [Calquence] and zanbrutinib [Brukinsa] which have come onto the market. A lot of those have come onto the market specifically due to some of the toxicities that we know exist with ibrutinib in the hope that these drugs have more fidelity to the BTK receptor and less off target impact. We may see less side effects and we will have in patients come off of ibrutinib [due to] bleeding, atrial fibrillation, arthralgias, myalgias, which are muscle and bone pain, and joint aches and pains, infection, and some of the newer cardiovascular risks that we see like hypertension and ventricular arrhythmias.

1:45 | It does appear that some of these side effects may be a class effect and not specifically related to ibrutinib. All in all, it does still appear that all these drugs are very efficacious. You have some different side effects between acalabrutinib, zanbrutinib, etc., but with more time, we will truly get a sense of the side effect profile of those drugs.