At December’s American Society of Hematology virtual meeting, researchers presented the 7-year long-term outcome analysis of the first study of a non-chemotherapy frontline treatment regimen with lenalidomide (Revlimid) plus rituximab (Rituxan), also called R2 or R2 (R-squared), as induction and maintenance therapy for mantle cell lymphoma (MCL).
The study results were presented by Samuel Yamshon, MD, a second-year hematology and medical oncology fellow at Weill Cornell Medicine and NewYork-Presbyterian Hospital in New York City, and in this video he offers his thoughts on where this new regimen fits in the frontline treatment of MCL.
Following is a transcript of his remarks:
That really is the main question here. I think it’s very difficult to compare across different regimens, particularly with ones that really represent totally different treatment paradigms. I think you can’t really say, obviously whether one is quote unquote better or worse, or that one is more or less toxic, but rather that they have totally different toxicity profiles. Obviously, R-squared is less intensive upfront, but it also continues for a really long time.
From our perspective, there’s still a lot of room to improve in terms of the durability of the responses, as well as the tolerability and we’re even now — given how durable some of these responses are for the people who are still on therapy — starting to think about possibly de-escalating in the future.
I think the other thing that’s important to note is that when this study was published in 2015, it was the first chemo-free approach in frontline mantle cell lymphoma. But since then, there have been a lot of other studies that have gone the chemo-free route and a lot obviously where they’re using BTK [Bruton’s tyrosine kinase] inhibition.
And one thing that we’re looking at at Cornell is the addition of acalabrutinib [Calquence] to this backbone. So, ALR — acalabrutinib, lenalidomide, and rituximab.
But I think the key is that we’re likely going to see an explosion of new therapies in the next few years, and it’s going to be hard to compare them directly without head-to-head studies.
But I think the important point to emphasize is that as more regimens come onto the scene, it gives clinicians options. And for patients that have individual comorbidities, but also wants and needs and goals for their therapy, I think it’s really exciting that we’re going to have options that allow people who are very averse to chemotherapy, that this could be an option for those patients.