Numerous therapeutic approaches have emerged over the last few years that have significantly changed the treatment landscape of mantle cell lymphoma (MCL). Current therapies consist of targeted approaches such as Bruton’s tyrosine kinase (BTK) inhibitors, which provide durable responses, while cellular therapies have shown impressive results and could help evolve the treatment landscape in relapsed MCL.
In this video courtesy of VJHemOnc, Jonathon B. Cohen, MD, MS, co-director of the lymphoma program and medical director of infusion services at Winship Cancer Institute of Emory University in Atlanta, provides an overview of the current treatment landscape for patients with relapsed MCL.
Following is a transcript of his remarks:
So management of relapsed mantle cell lymphoma continues to evolve each year. Fortunately, there are a number of projects being done, studies being conducted that are helping us know more about how to manage patients who present with relapsed disease.
In the recent past, our first choice had been to proceed with a BTK inhibitor, especially at the time of first relapse. There are now three currently available BTK inhibitors on the market, with several others that are currently being investigated.
The BTK inhibitors are quite effective in this setting, although unfortunately, compared to what we see in CLL [chronic lymphocytic leukemia] none appear to have the long-term remission that we’ve seen in that disease. So for example, in mantle cell lymphoma most patients are progressing around the 2-year mark. Some certainly stay on treatment longer. Others may progress a little bit earlier. There are other new therapies that are also available, including lenalidomide, and often we consider off-label use of venetoclax.
Up until recently our primary goal for patients with relapsed mantle cell lymphoma was to prolong their life expectancy and quality of life with the multiple oral agents and other therapies available. However, we’ve seen the approval of the first CAR [chimeric antigen receptor]-T cell product for patients with relapsed mantle cell lymphoma. And I am confident that this will significantly change the landscape of this disease.
Whereas before we were aiming for several years of remission and good quality of life, the hope now with CAR-T cell therapy is that those patients who do ultimately respond and achieve a complete remission after CAR-T, will enjoy a prolonged remission duration — hopefully of many years or potentially even indefinitely.
Certainly more follow-up will be needed to find out whether this ultimately is true. But what we do know is that the response rates to CAR-T cell therapy are quite high, even in those patients who have progressed after multiple prior lines of therapy, and it’s a very promising new agent.
I think in the coming years, we’ll be hopefully learning more about where to sequence CAR-T cell therapy and the management of patients with relapsed mantle cell lymphoma, as well as determining a better, more personalized approach to management of patients with relapsed mantle cell lymphoma.
Last Updated February 23, 2021