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Novel agents improve MCL care, tumor profiling key to further advances

Wednesday, October 21, 2015

John Leonard, M.D.John Leonard, M.D. Novel agents have transformed the treatment of mantle cell lymphoma and tumor profiling is poised to further enhance these benefits, according to John P. Leonard, MD.

Leonard, the Richard T. Silver Distinguished Professor of Hematology and Medical Oncology at Weill Cornell Medical College, discussed his approach to MCL management and advances in treating the disease at the inaugural ASH Meeting on Hematologic Malignancies.

Leonard, outlined two key principles of his treatment approach.

The first is to observe asymptomatic MCL patients for as long as possible. In discussing the “watch and wait” approach, Leonard referred colleagues to data from the 2009 study he co-authored in the Journal of Clinical Oncology.1 The overall survival (OS) of patients in the observation group exceeded that of patients in the early treatment group.

His second key principle is to begin with less-intensive initial treatments when needed due to their lower toxicity levels. “It’s true that less intensive treatments might have more chronic toxicity, but intensive treatments are, unquestionably, more toxic in the short term and can have longer-term toxicities as well,” he said.

Leonard provided a list of “standard” initial treatment options, noting that MCL treatment remains officially nonstandardized. In addition to observation, he grouped R-CHOP, modified R-HyperCVAD, R-CHOP/RIT and R-bendamustine as less intensive options. More intensive treatment options were:

  • R-CHOP/DHAP/autologous stem cell transplant
  • R-HyperCVAD/MTX/Ara-C
  • R-HyperCVAD/MTX/Ara-C/autologous stem cell transplant
  • Nordic

Leonard’s preferred initial treatment for symptomatic patients is bendamustine-rituximab. For maintenance treatment, he uses rituximab or novel approaches. He cited the 2013 study by Rummel et al in the Lancet.2 Patients in the bendamustine-rituximab group experienced increased progression-free survival with fewer toxic effects.

Leonard discussed approved and potentially promising agents for treating MCL, reviewing key clinical trials for bortezomib (Velcade), lenalidomide (Revlimid), temsirolimus, everolimus (Afinitor), palbociclib (Ibrance), venetoclax (ABT-199), and ibrutinib (Imbruvica). 

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This is an excerpt of an article that appeared in OncLive. Read the full story here.