Better targeted therapies likely coming for lymphoma subtype

ATLANTA — Advances in the treatment of mantle cell lymphoma comprised several studies presented at the ASH Annual Meeting and Exposition.

HemOnc Today spoke exclusively with Stephen Douglas Smith, MD, medical oncologist at Seattle Cancer Care Alliance and an associate professor at the University of Washington School of Medicine, about the results and how treatment options are advancing.

Smith highlighted results of an updated study from Jia Ruan, MD, PhD, of Weill Cornell Medicine in New York, and colleagues that assessed a nonchemotherapy approach as a first-line treatment option. This study demonstrated a “fairly favorable toxicity profile and long-term remissions in a high proportion of patients,” Smith said.

Patients treated with a combination of lenalidomide (Revlimid; Celgene) and rituximab (Rituxan; Genentech, Biogen) in first-line treatment demonstrated complete and durable responses.

Three-year PFS was 80.3% (95% CI; 63-90.1) and 4-year PFS was 69.7% (95% CI; 50.6-82.6). Three-year OS was 91.9% (95% CI; 76.9-97.3) and 4-year OS rate was 82.6% (95% CI; 65.3-91.9).

Smith noted that the small population size (n = 38) warranted further prospective testing.

Smith also highlighted results of the phase 2 ACE-LY-004 trial, which assessed the use of acalabrutinib (Calquence, AstraZeneca) for the treatment of adults with mantle cell lymphoma who have received at least one prior therapy. Acalabrutinib received accelerated approval from the FDA in October.

Patients who received acalabrutinib (n = 124) had an investigator-assessed overall response rate of 81% (95% CI; 73-87), and 40% (95% CI, 31-49) achieved a complete response.

“I think acalabrutinib will be thrust into the standard of care, but also into new combinations,” Smith told HemOnc Today. “We’re seeing improved safety profiles with some of the targeted therapies and combinations. Moving them closer and closer to first-line therapy will become more common and may help us solve the problem of some of the high-risk patients that have been so hard to get into remission.”

Smith said that longer-term follow-up will better assess the durability of the remissions.

“I think we’re getting to better targeted therapies,” he said. “In the same vein, we have more PI3 kinase inhibitors coming out, and the safety profile is going to get better over time.”

Another active area in research over the next 5 years likely includes identifying better induction regimens prior to autologous transplant for patients with mantle cell lymphoma.

It is going to become more important for physicians treating mantle cell lymphoma to decide how hard to push a patient early on in the course of the disease, according to Smith who feels that a better and improved use of minimal residual disease assessment will help with that decision.

“Mantle cell lymphoma is a disease that’s becoming a marathon,” Smith said. “We still have high-risk patients with a lot of problems with their disease within the first couple of years [of diagnosis], but median survivals are increasing.” – by Ryan McDonald

Reference:

Gerson JN, et al. Abstract 341. Presented at: ASH Annual Meeting and Exposition; Dec. 9-12, 2017; Atlanta.

Ruan J, et al. Abstract 154. Presented at: ASH Annual Meeting and Exposition; Dec. 9-12, 2017; Atlanta.

Wang M, et al. Abstract 155. Presented at: ASH Annual Meeting and Exposition; Dec. 9-12, 2017; Atlanta.

Disclosure: Smith reports research funding from Acerta.