Evaluating Recent Study Findings on Treatment Combinations for Patients With MCL

At the 2024 Great Debates & Updates (GDU) in Hematologic Malignancies meeting in New York, Jia Ruan, MD, PhD, Weill Cornell Medicine, New York, shares expert insight regarding recent and ongoing studies on treatment combinations for elderly and/or high-risk patients with mantle cell lymphoma (MCL), such as the BOVen trial.

Transcript:

Hi, good morning, I'm Dr. Jia Ruan. I'm a physician taking care of patients with lymphoma at Weill Cornell, New York Presbyterian Hospital.

It's my pleasure to be here today. We have a conference, [the] Great Debate[s] & Update[s] in Hematologic Malignancies meeting in New York]. The topic that I [presented] for today's meeting is on the frontline treatment of patients with mantle cell lymphoma. In particular, I discuss[ed] non-chemotherapy novel treatment combination[s].

Reported recently was the phase 2 BOVen study for patients with untreated but high-risk mantle cell lymphoma, those with tumor protein p53 (TP53) mutation. The study was done [in] a multi-center setting and led by Sloan Kettering [Cancer Center]. The combination included zanubrutinib, venetoclax, and as well as obinutuzumab. The triplet combination has shown to be very highly effective with [a] [complete remission] (CR) rate [of] close to 70%, and 2-year progression-free survival of close to 70%, especially in a high-risk population [with] TP53 mutation. That was compared with historical control [with a] much higher progression-free survival. We think that this is a very promising combination as a chemotherapy-free, novel agent-based combination.

[In] other combinations, including lenalidomide-based, we have the [rituximab] (R)-squared, so lenalidomide plus rituximab, which is the longest follow-up for novel agents. Building upon the R-squared for the frontline, we also have the ALR, which is acalabrutinib-lenalidomide-rituximab, which has shown very high response rate, including [measurable residual disease] (MRD) and detected rate.

There's also R² plus venetoclax as a triplet [therapy], which has shown high efficacy and [is] pretty well tolerated as well. In summary, I think we now have a spectrum and combination of novel agents that are studied in phase 2 settings that have generated good efficacy data, very tolerable side effect profiles, and good quality of life for our patients.

Next, we look forward to ongoing phase 3 data where the combination of novel agents are being compared with chemoimmunotherapy. Some examples include, in more elderly patients, the ENRICH study as well as Mangrove study. Hopefully, we will know the outcome of those stud[ies] very soon which could further provide guidance in terms of where is [the] direction for patients in the front-line setting. Should we prioritize non-chemotherapy-based combinations? Do they compare more favorably, or at least non-inferior, compared with chemoimmunotherapy? Thank you very much.

Source:

Ruan J. Debate - Novel, “Non-Chemotherapy” Approaches Are Best for Initial Therapy for Mantle Cell Lymphoma. Presented at the Great Debates and Updates in Hematologic Malignancies Meeting; April 5-6, 2024; New York, New York.