VIDEO: BTK inhibitors may reduce need for intensive induction therapy in mantle cell lymphoma

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So I think that actually, to be honest, could be an entire session all by itself, because lots of ways in which BTK inhibitors are impacting treatment. I would say my summary, if I was to say putting it all together, in patients receiving less intensive induction treatment, the addition of a BTK inhibitor does seem to be significantly beneficial. When one uses a very intensive induction therapy, there have been some recent data that the addition of a BTK inhibitor may actually increase toxicity and not necessarily have as much of a benefit.

So my takeaway from that is, we're beginning to move into an age where the super intensive approaches in induction are actually being diminished, and BTK inhibitors can be added to get the benefit without having to go in, as it were, so hard on the treatment side of things. That really has impacted in many respects kind of whether intensive therapy overall is needed. Triangle study, for example, showed that when you add a BTK inhibitor to the maintenance therapy, it's very questionable, and in fact, recent updates of that trial suggests that an autologous transplant really does not add to the benefit of patients when you're using a BTK therapy in maintenance. So it's changing induction therapy. It's also changing maintenance therapy. I alluded to this earlier.

We're also learning that if you use MRD, and at the end of your induction treatment, the MRD is negative, a transplant is also not really beneficial. So I think we can approach mantle cell lymphoma with a less intensive induction and then a consolidation maintenance approach utilizing a BTK in both of those phases, often in combination with rituximab. Furthermore, I think as you're looking at older patients, even the kind of more modest rituximab plus a BTK inhibitor, recent data says that compared to a more typical chemo immunotherapy approach, that addition of the BTK inhibitor is more beneficial. So I think we're seeing both in the younger patients, a de-intensification and a maintenance strategy and dropping the transplant, and in older patients, an even further, more modest, easier to tolerate therapy with an ongoing long-term kind of treatment.

We're also learning in the relapse space, particularly if you didn't receive a BTK inhibitor as your frontline treatment, that is really a standard, and there are multiple new versions of BTK inhibitors that are currently being tested and can actually provide benefit, even if you receive a BTK inhibitor. And then if you receive an alternative BTK inhibitor thereafter, you can benefit yet again. There still remains some pockets of people that are a little hard to treat, and I think p53 patients and patients with blastoid morphology and the like still remain challenging. But that's kinda where BTK inhibitors, certainly to date, have made the biggest impact.