Significance of the TRIANGLE Study of Frontline Ibrutinib for MCL

Yazan Samhouri, MD, a hematologist/oncologist in the division of hematology and cellular therapy at Allegheny Health Network Cancer Institute, discusses his impressions of the TRIANGLE clinical trial (NCT02858258) presented at the 2022 American Society of Hematology Annual Meeting (ASH).

The phase 3 trial of patients with mantle cell lymphoma (MCL) could have practice-changing impact, Samhouri says. MCL is a heterogenous disease with indolent and aggressive forms and researchers are looking into ways to improve outcomes, since it is still an incurable disease.

The TRIANGLE study enrolled 870 patients with MCL into 3 arms, 1 receiving standard chemotherapy followed by autologous stem cell transplant (ASCT) and rituximab (Rituxan) maintenance, 1 with the addition of the Bruton tyrosine kinase inhibitor (BTKi) ibrutinib (Imbruvica) to this standard-of-care regimen, and 1 with ibrutinib but without ASCT.

The results presented at ASH showed an 88% 3-year failure-free survival for ibrutinib added to chemoimmunotherapy and ASCT versus 82% for chemotherapy and ASCT. Ibrutinib also did not appear to increase toxicity significantly. Samhouri says he is interested in seeing longer follow-up on these data, which is needed to determine the role of ASCT in patients receiving a BTKi with frontline therapy.

TRANSCRIPTION:

0:08 | We had the TRIANGLE clinical trial presented as a plenary session abstract, which talks about adding BTKi and ibrutinib to chemotherapy as first line in MCL. MCL is an interesting and challenging disease to treat because it's very heterogeneous. There are indolent forms of MCL. There's an aggressive [form] and there is a very aggressive form, which is a TP53 or blastoid form. We are always looking into improving the treatment landscape and [improving] outcomes for our patients with this disease. We cannot cure MCL yet, so adding a BTKi like ibrutinib to first-line chemoimmunotherapy seems to be doing really good.

1:01 | The presentation yesterday [at ASH] was a clinical trial where they [investigated] it in almost 900 patients randomized into 3 arms. [One] arm got the standard-of-care chemotherapy followed by a transplant followed by maintenance rituximab, which is our current approach. Another arm had standard chemotherapy plus ibrutinib, followed by transplant and maintenance rituximab and ibrutinib, and the third arm without transplant. It seems that adding ibrutinib has real benefit and more importantly, it didn't seem that it increased the toxicity a lot. This is something important that we are looking at, so we are excited to see more follow-up on these data, which is going be practice changing in the field of MCL.