Fighting Mantle Cell Lymphoma
- Some mantle cell lymphomas grow slowly and don’t usually need to be treated right away, while others grow quickly and may need immediate treatment.
- Treatment often pairs chemotherapy with a targeted therapy (called chemoimmunotherapy: a combination chemotherapy and immunotherapy).
- Physicians use the monoclonal antibody drug, rituximab (Rituxan), and chemotherapy, followed by stem cell transplantation.
- A prominent study demonstrated that certain younger patients with mantle cell lymphoma who receive ibrutinib (Imbruvica) combined with standard first-line treatment can avoid autologous stem cell transplantation (ASCT).
- We can expect a new standard of care with the addition of ibrutinib to frontline management of young patients with MCL.
“One feature that makes it somewhat unique is that it’s a very heterogeneous group of diseases,” Dr. Jakub Svoboda, medical oncologist at Penn Medicine, told SurvivorNet in a previous conversation. “Even though it’s just under one label, we have patients with mantle cell lymphoma who may have a very indolent or slow-growing disease, and then we have patients who may have quite aggressive disease. And so, it’s somewhat challenging for clinicians and patients to treat this disease because there’s perhaps different options for different situations.”
First-line Standard TreatmentRead More
The CHO in CHOP stands for three chemotherapy drugs – cyclophosphamide (C), doxorubicin hydrochloride (H), and vincristine (Oncovin – O). The final drug is the steroid, prednisone, which helps to bring down inflammation throughout your body.
The drug Ibrutinib (brand name Imbruvica) taken as a daily oral medication is currently approved for patients with relapsed/refractory mantle cell lymphoma and has shown to be effective.
According to new data from the randomized, phase III SHINE trial, Ibrutinib in combination with the standard of care regimen can improve progression-free survival, or PFS, by 2.3 years among newly diagnosed patients with MCL.
American Society of Hematology Annual Meeting News
Some very interesting data is being presented at American Society of Hematology (ASH) Annual Meeting.
“The European study is part of the important effort in oncology to improve outcomes and reduce toxicities for our patients by using novel agents in earlier lines of therapy.” – Dr Jakub Svoboda, a medical hematologic oncologist at Penn Medicine and associate professor of medicine at the Hospital of the University of Pennsylvania, told SurvivorNet in a new and exclusively interview.
This study demonstrated that certain younger patients with mantle cell lymphoma who receive ibrutinib (Imbruvica) combined with standard first-line treatment can avoid autologous stem cell transplantation (ASCT).
“My take-home message based on the data from the plenary session by Dr. Dreyling is that ibrutinib provides benefit when added to the current treatment used in younger patients with MCL. There were no red flags in terms of the additional toxicities in this setting, probably because these were mostly fit, younger patients.” – added Dr Svoboda.
Investigators set out to see if the addition of ibrutinib to the standard regimen of immunochemotherapy and ASCT improved failure-free survival rates and whether adding ibrutinib eliminated the need for transplantation. The results of the study show that ibrutinib paired with chemoimmunotherapy was as effective as chemoimmunotherapy with ASCT. The researchers also found that adding ibrutinib to standard chemoimmunotherapy plus transplant improved efficacy. They are still investigating the comparison between ibrutinib plus chemoimmunotherapy versus ibrutinib, chemoimmunotherapy, and transplant combined.
However, Dr. Jane Winter, a hematologist at the Robert H. Lurie Comprehensive Cancer Center at Northwestern University and ASH president said that additional follow-up will be required to show definitively whether ASCT is unnecessary when ibrutinib is used. “Patients and their hematologists look forward to these results in hopefully eliminating the need for auto-transplants in mantle cell lymphoma.”
According to Dr. Svoboda, the follow-up is still too short to answer the big question whether using ibrutinib may eliminate the need for consolidative autologous stem cell transplant, but we may get additional information as the data matures. Dr. Svoboda concludes, “Personally, I hope that the future treatment strategies for MCL, including the frontline management, will be based on the individual biology of the tumor and that the one-size-fits-all approach will not apply for much longer. That will allow us tailoring the therapy to be most effective while sparing patients unnecessary toxicities from overtreatment.”
The TRIANGLE study
Patients with newly diagnosed grade II-IV mantle cell lymphoma, who were less than 65 years old and suitable for high dose chemotherapy were randomized in 1:1:1 into 3 trial arms. These arms included:
- Chemoimmunotherapy (Arm A-SOC)
- Chemoimmunotherapy plus ibrutinib (A+I, I).
- Transplant was planned for patients in Arm A and A+I who responded to the chemoimmunotherapy.
Addition of ibrutinib to chemo-immunotherapy and autotransplant (A) was superior to SOC in terms of failure free survival at 3 years. SOC failed to show superiority over ibrutinib without transplantation.
It’s an oral medication that can change the way that cells work and help the body control the growth of cancer.
Imbruvica a type of cancer growth blocker called a tyrosine kinase inhibitor (TKI). Tyrosine kinase inhibitors block chemical messengers (enzymes) called tyrosine kinases. Tyrosine kinases help to send growth signals in cells, so blocking them stops the cell growing and dividing.
The side effects of tyrosine kinase inhibitors are usually mild and should improve with time. They can include:
- Fatigue (feeling and being sick/Tiredness)
- Abdominal (tummy) pain
- Swelling in the face and lower legs
- Muscle cramps/pain
Questions to Ask Your Doctor
- Am I eligible to receive Imbruvica?
- Am I more, or less, likely to respond to this treatment?
- How will I feel during treatment?
- What are the most common side effects of it?
- What will my treatment cost? Will my treatment be covered by my medical insurance?
- Should I get a second option regarding my diagnosis?
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