Decades of MCL Treatment Advancements a ‘Godsend’ for Patients

Treatment — and patient outcomes — for mantle cell lymphoma (MCL) look very different than they did years ago, with Bruton tyrosine kinase (BTK) inhibitors offering a safe and effective way to treat their disease. However, with many patients still relapsing after transplant, there is still plenty more work to be done, explained Dr. Jeffrey R. Schriber, director of hematologic malignancies at the Cancer Treatment Centers of America in Phoenix.

“There’s been an explosion (of improvement), not just in this malignancy, but in every hematologic malignancy. It is completely different than it was 20 years ago,” Schriber said in an interview with CURE®, where he outlines exciting advancements over the last two decades in light of CURE®’s 20thanniversary.

BTK Inhibitors Are Tolerable and Effective

There are currently three BTK inhibitors that are approved by the Food and Drug Administration (FDA) for the treatment of MCL: Imbruvica (ibrutinib), Calquence (acalabrutinib) and Brukinsa (zanubrutinib). Since these drugs seek out and target only the cancer cells, they tend to be more tolerable than the aggressive chemotherapy that has traditionally been used to treat the disease, Schriber explained.

“What we’ve started to recognize is that in patients who fail these types of therapies — and unfortunately many of them still do — there are now therapies that we could use, focused on the immune system,” Schriber said, explaining that he was recently treating a patient with upfront chemotherapy. The patient’s quality of life was drastically impacted by the side effects, and he was losing weight. Schriber was not sure the patient could tolerate the final dose of chemotherapy, so he switched him to a BTK inhibitor.

Now, the patient is gaining weight, feeling great and his blood counts continue to drift up — all good signs for someone with MCL. “This has been a godsend for him,” Schriber said.

However, BTK inhibitors are not currently approved for upfront usage, meaning that patients must first undergo chemotherapy before being prescribed one of these agents. Schriber hopes that current ongoing research will change this in years to come. Or, he said that perhaps there is a way to combine or alternate BTK inhibition and chemotherapy treatment to produce the best outcomes for each individual patient.

“There’s lots of trials going on right now that will help define the way that we should best treat these patients down the road,” Schriber said.

Maintenance Therapy Improves Post-Treatment Outcomes

Another major advancement in the treatment field of MCL is the advent of maintenance therapy. That is, most patients should stay on anti-cancer drugs after their main treatment, be it chemotherapy, BTK inhibitors or autologous stem cell transplantation.

“You can’t just exercise for a week or floss for a week or two. You’re supposed to do that on an ongoing basis. Well, it turns out that (treating MCL) is like that too,” Schriber said. “We’ve determined that after a transplant, or after you complete your therapy, you should do maintenance therapy for probably about two years.”

Most of the time, maintenance therapy is via Rituxan (rituximab), a monoclonal antibody drug that typically administered every other month and is well-tolerated. Schriber said that data has shown that this leads to a significant increase in survival.

What’s Next in MCL Treatment?

Despite the inroads that BTK inhibitors and maintenance therapy have made in MCL treatment, there is still much more to be done for this disease.

Not only are BTK inhibitors still reserved for use after upfront chemotherapy, but many patients also relapse after undergoing transplantation, outlining two crucial areas of unmet need, Schriber said.

However, ongoing research is addressing both issues, and Schriber is excited to see how the field will continue to change.

“There’s still work to be done, but I’m very optimistic about where we’re going in the future.”

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