Dr Danilov on Questions Remaining Across the Treatment Landscape of MCL

Alexey Danilov, MD, PhD, associate director, Tino Stephenson Lymphoma Center, professor, Division of Leukemia, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, discusses lingering questions that remain across the treatment landscape of mantle cell lymphoma (MCL).

The introduction of BTK inhibitors has sparked evolution in the treatment landscape for patients with MCL, Danilov begins, adding that this field continues to rapidly evolve. However, following the emergence of these agents, several questions still remain, he notes. One key question centers around determining the optimal therapy is for different subsets of patients and how a precision medicine approach can be applied in MCL, Danilov explains. For example, it is still being determined if treatment decisions should be different for patients with p53-mutated MCL, and Danilov varying approaches should be used for this subset.

Second, a better understanding is needed for the role of autologous stem cell transplant as consolidative strategy in the frontline setting for patients with MCL, he says. Another area to address with the implementation of new therapies within this space is whether patients with MCL can undergo initial induction therapy without chemotherapy, Danilov continues. Examples of chemotherapy-free induction could include a lenalidomide (Revlimid)-based approach or regimens incorporating a BTK inhibitor, Danilov expands.

Finally, it will be important to determine optimal treatment approaches for patients who progress on BTK inhibitors or CAR T-cell therapy, Danilov continues. The noncovalent BTK inhibitor pirtobrutinib (Jaypirca) was approved by the FDA in January 2023 for the treatment of adult patients with relapsed or refractory MCL following at least 2 lines of systemic therapy, including a BTK inhibitor. Determining exactly how noncovalent BTK inhibitors could be used in these later settings will also have an impact on the MCL treatment paradigm, he concludes.