Dr. Bijal Shah on Bortezomib's Impact on Treatment of MCL

Bijal D. Shah, MD, medical oncology, Moffitt Cancer Center, discusses the impact of the approval of frontline bortezomib for the treatment of mantle cell lymphoma (MCL).

Shah admits he is struggling in treating patients with MCL with bortezomib in the frontline setting. It is not a treatment option often used at Moffitt Cancer Center due to the neuropathy associated with it. Though administering bortezomib subcutaneously has helped lessen the grade 3 adverse event, practitioners still see grade 2 neuropathy.

An overall issue with bortezomib, Shah says, involves the phase III study comparing bortezomib to rituximab, cyclophosphamide, doxorubicin, and prednisone plus vincristine (R-CHOP) for patients ineligible for bone marrow transplantation. The study was done without maintenance therapy.

Shah is unsure if maintenance will involve single-agent rituximab. An ongoing, randomized study is comparing bendamustine and rituximab to bendamustine, bortezomib and rituximab. A second randomization is comparing maintenance with rituximab to lenalidomide.