Dr. Leslie on the Need for Clinical Trials to Address Unmet Needs in MCL

Lori A. Leslie, MD, a hematology-oncology specialist with John Theurer Cancer Center, discusses the importance of clinical trials for developing novel, up-front therapy options for patients with mantle cell lymphoma (MCL).

MCL is a complicated landscape and disease type, says Leslie. When making decisions in the up-front setting, several factors must be considered, such as age, comorbidities, and what is driving the lymphoma, explains Leslie.

Options in this setting include high-dose chemotherapy with or without autologous stem cell transplant. For older or less fit patients, bendamustine with rituximab (Rituxan)-like regimens are an option. For a rare subset of patients, the “watch-and-wait” approach is viable, but that is less commonly done for patients with indolent disease.

In those with p53 abnormalities, clinical trial participation is critical, Leslie adds. Many ongoing trials are examining the use of novel targeted therapies, such as BTK inhibitors, as well as combination therapies with BCL-2 inhibitors and CD20 antibodies in the frontline setting for patients who have p53 abnormalities.

Even with aggressive approaches such as chemotherapy, transplant, and maintenance rituximab, which has shown an overall survival benefit in patients, those who harbor p53 abnormalities do not do as well, says Leslie. Thus, an area of unmet need is present with regard to those patients. Even in the frontline setting, clinical trial opportunities should be capitalized on, concludes Leslie.