Dr. Phillips on Emerging Combination in MCL

Tycel J. Phillips, MD, assistant professor, University of Michigan Cancer Center, discusses an emerging treatment combination for patients with mantle cell lymphoma (MCL).

MCL is a rare subset of non—Hodgkin lymphoma (NHL) that affects about 5% to 6% of patients with NHL, Phillips says, although it is more commonly seen in male patients who are >65 years old. Currently, there is not a well-established standard of care for these patients, but a lot of ongoing research is geared toward addressing this unmet need in both transplant-eligible and -ineligible patients.

In terms of chemotherapy, bendamustine has proven to be an effective regimen with rituximab (Rituxan) maintenance, while in the relapsed/refractory setting, BTK inhibitors have shown promise, particularly with the rise of the second-generation inhibitor acalabrutinib (Calquence).

In a study presented at the 2018 ASH Annual Meeting, patients received oral acalabrutinib 100 mg twice daily, bendamustine at 90 mg/m2intravenously on days 1 and 2, and rituximab at 375 mg/m2 on day 1 in each 28-day cycle. Acalabrutinib was given until disease progression or intolerance and BR was repeated every 28 days for up to 6 cycles.

In previously untreated patients, the overall response rate (ORR) was 94% and complete response rate (CR) was 72% with the combination, while the relapsed/refractory arm had an ORR of 85% and a CR rate of 65%.