Promising Advances in the Mantle Cell Lymphoma Treatment Landscape

Eliza A Hawkes, MD, Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia, shares some of the rapidly evolving treatment approaches for mantle cell lymphoma (MCL), including chemotherapy-free options and assessing responses through minimal residual disease (MRD) technologies.

Transcript: 

Dr Hawkes: My name is Eliza Hawkes. I'm an associate professor and clinician at the Olivia Newton-John Cancer Research Institute at Austin Health, as well as Monash University in Melbourne, Australia. 

Oncology Learning Network: How has the mantle cell lymphoma treatment landscape changed in the past few years? Are there any advancements that you are particularly excited about?

Dr Hawkes: Mantle cell lymphoma treatment has evolved very rapidly in the last 5 to 6 years. We relied heavily on chemotherapy before the advent of the Bruton’s tyrosine kinase (BTK) inhibitors, which are now available in many jurisdictions for relapsed disease. But also, I think the era of immunotherapy has really improved outcomes for mantle cell lymphoma. 

Historically, we used to give very intensive chemotherapies because we know that mantle cell lymphoma relapses, and in the past when it relapsed, it was really unresponsive to chemotherapy in later lines of treatment. But now, with new small molecules such as the Bruton’s tyrosine kinase inhibitors and also [B-cell lymphoma 2] (BCL-2) inhibitors, but equally with bispecifics and [chimeric antigen receptor] (CAR) T[-cell therapy], that landscape has changed. 

Now, it's really just about how much less chemotherapy we can give and how we can replace that with some of the newer agents. We've got now completely chemo-free upfront studies running. The AstraZeneca TrAVeRse study, which is acalabrutinib, rituximab, and venetoclax, and using MRD technologies, new ways of assessing response, where we are seeing a better appreciation of deep complete responses, not just imaging. 

It's a really exciting time to be treating this disease, and I think in the future we will be using combinations of novel therapies, immunotherapy, [and] cellular therapies as opposed to chemo being at the forefront. 

Having said that, chemotherapy for a lot of people is a very effective treatment, [but] it's not without toxicity. We've just seen some long-term follow-ups from some of the chemotherapy studies, and the outcomes are okay, but I think there's definitely room for improvement and the newer agents will do that.

Source: 

Hawkes EA, Lee ST, Churilov L, et al. A window study of acalabrutinib & rituximab, followed by chemotherapy & autograft (ASCT) in fit patients with treatment naïve mantle cell lymphoma (MCL): first report of the investigator-initiated Australasian leukaemia & lymphoma group NHL33 ‘Wamm’ trial. Presented at the ASH 65th Annual Meeting & Exposition; December 9-12 2023; San Diego, California. Abstract 735