Dr Phillips on the Evolution of the MCL Treatment Paradigm

Tycel Phillips, MD, hematologist-oncologist, associate professor, Division of Lymphoma, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, discusses the evolution of treatment for patients with mantle cell lymphoma (MCL).

Following his presentation at an OncLive^® State of Science Summit™ on hematology, Phillips says oncologists are gradually transitioning away from using chemoimmunotherapy in patients with MCL. Many trials are now incorporating novel drugs, which have shown promise in the relapsed/refractory setting, into frontline treatments, he reports. This shift indicates a gradual rollback of traditional approaches, according to Phillips. For younger patients, this change marks a move toward limiting exposure to autologous stem cell transplantation (ASCT), Phillips explains. Instead of following historically broad patterns of ASCT use, this procedure will be reserved for patients who stand to benefit the most from it, he notes.

For older patients, treatment standards are trending toward understanding that combining chemotherapy with novel therapies might not be the best approach, Phillips expands. These patients may derive more benefit from novel treatments and antibodies alone, without the added burden of chemotherapy, he says. However, this shift also has implications for second-line treatments and beyond, Phillips notes. As some of the best drugs are being used earlier in the treatment process, there is a need to rethink the current treatment paradigm, Phillips emphasizes.

Traditionally, the treatment sequence for MCL has been chemotherapy followed by a BTK inhibitor and then other drugs, Phillips says. The shift of BTK inhibitors to the frontline setting will push some advanced treatments, such as CAR T-cell therapy and bispecific antibodies, into earlier lines of therapy, he continues.

Determining the optimal treatment approaches in the second- and later-line settings will be a critical discussion point in the future, he says. The shift away from frontline chemoimmunotherapy underscores the importance of continuous evaluation and adaptation of treatment protocols to ensure the best outcomes for patients with MCL, Phillips concludes.