VIDEO: New treatment approaches may benefit patients’ quality of life

Editor’s note: This is a previously posted video, and the below is an automatically generated transcript to be used for informational purposes. Please notify editor@healio.com if there are concerns regarding accuracy of the transcription.

You know, by and large I would say we're doing a much better job than we did. And what do I mean by that? Well, you know, if you go back, I don't know, 10 years it was hyper-CVAD and autologous stem cell transplant. And, there's no way to put it subtly, that's hard, okay? If you want to say maxi-CHOP instead of hyper-CVAD, it's the same thing. It's intensive chemotherapy, high-dose cytarabine, followed by a stem cell transplant, wow. You know, we're better than we were then. We're starting to deintensify that chemo backbone a bit. I do think the R-CHOP/R-DHAP approach is a little easier than hyper-CVAD and it seems to provide good responses. It's still intensive chemotherapy. It still benefits from stem cell transplant consolidation, we think. We're doing a trial now to determine that with certainty. But we're getting better in that sense. And so those are for the younger patients we have with mantle cell. For the older patients, we are moving towards far less intensive approaches because we recognize that they're much less likely to be well tolerated. What I'm excited about, this is probably not gonna shock you 'cause you heard me allude to it with the first question, is I'm happy that we're starting to move away from bendamustine. And you know, I say that because, you know, while bendamustine's a good drug, it does provide for durable remissions, it is chemotherapy and, you know, there is some toxicity as it relates to infectious risk, as it relates to second malignancy risk and the like that I'm hopeful we'll be able to save our patients from. And so as we bring some of our novels, REVLIMID, BTK inhibitors, and the like, into the frontline setting, I'm excited. I'm excited about sort of steering away from those more significant complications. In terms of quality of life on REVLIMID or a BTK, it's not perfect by no means and I think that, while most of the side effects are easily managed, fatigue is one that we still struggle with. And, you know, we don't have good medications for fatigue. And so, you know, I have found that sometimes cycling between different BTK inhibitors can improve that side effect. That's one nice thing is, you know, it's sort of like if you talk to someone who's been on Allegra who goes to a different histamine blocker, for reasons you can't explain the fatigue is magically better and their allergies are still controlled and you feel really good about that. And the BTK is, I think, kind of the same line. And so sometimes you can improve things that way. With lenalidomide or REVLIMID, I focus more on trying to abbreviate the course of therapy. You heard me allude to that a little bit when I was talking about MRD kinetics, but, you know, for patients who become MRD negative very quickly, within two or three months of starting their REVLIMID, I'm not afraid of shortening that course to six to 12 months, you know, and just using the rituximab piece then to carry them, you know, to carry them forward. And so I think that there are similar approaches along those lines where we really try to tailor the duration of the novel to try and improve on patient's quality of life. You know, as we start talking about CAR T-cell immunotherapy I do think that that's, again, another major improvement. Now with that said, there's gonna be a period of a few months, you know, in that CAR T period where we absolutely expect fatigue, absolutely affect, you know, some degree of decreased function, whether that's just due to the low blood counts or just some muscle breakdown during the course of therapy, meaning just from, you know, being in bed while they're receiving their CAR T-cells. But what's amazing is, you know, you fast forward, you know, to about three months or, you know, six months from CAR T and they feel exceptionally well, they feel normal, you know, provided that therapy's working. And then you have years of just watching, right? There's no maintenance component, at least that we've built in as a standard approach yet for CAR T. It's just watching. And that's pretty wild, you know, to take someone who may have been very, very symptomatic with their mantle cell or with the therapies we're giving for their mantle cell and to be able to watch them without any therapy and see them do well and sort of get back to get back to living. And so I think that that's another thing that I'm pretty excited about.