Ibrutinib Plus Venetoclax Is a Potential Second-line Regimen in MCL

Constantine S. Tam, MD

Constantine S. Tam, MD, leader of the Chronic Lymphocytic Leukemia and Low-Grade Lymphoma Program at the Peter MacCallum Cancer Centre, discusses how ibrutinib (Imbruvica) plus venetoclax (Venclexta) regimen from the SYMPATICO 2938 trial (NCT03112174) may fit in the relapsed/refractory mantle cell lymphoma (MCL) setting.

At the moment, the frontline standard of care for younger patients with MCL remains chemotherapy and autologous stem cell transplantation, according to Tam. When using ibrutinib monotherapy, if patients relapse from frontline chemotherapy, ibrutinib or another Bruton's tyrosine kinase inhibitor is the standard of care as a second-line therapy.

Tam says the investigators hope this study will show that the ideal second-line therapy should be a combination of ibrutinib or venetoclax after relapse. Additionally, for patients who have a TP53 mutation, where chemotherapy outcomes are poor, this is potentially a combination that may be active in the frontline setting for MCL. The SYMPATICO 2938 study has a randomized arm testing this secondary hypothesis. Patients who are either unfit for chemotherapy, or who are not suitable chemotherapy by virtue of their mutations, receive the ibrutinib and venetoclax combination. This is a third arm of the study that has not yet been reported.