Dr. Nowakowski on Next Steps With Emerging Agents in MCL

Grzegorz S. Nowakowski, MD, an assistant professor of Medicine at Mayo Clinic, discusses the status of emerging agents moving through the pipeline of mantle cell lymphoma (MCL).

The agent that is closest to frontline therapy is the combination of lenalidomide (Revlimid) and rituximab (Rituxan), Nowakowski explains, which is also known as R-squared. This combination has been compared in a randomized study against chemoimmunotherapy with results that are now maturing. Another study demonstrated the benefit of maintenance therapy with rituximab in the post-induction setting for elderly patients, as well as following high-dose chemotherapy and autologous transplantation in young and fit patients.

Targeted therapies are being tested in the relapsed/refractory setting and are slowly moving to the upfront setting, he explains. Ibrutinib (Imbruvica) is one that has significant single-agent activity in MCL. The addition of ibrutinib is being studied with bendamustine and rituximab (BR) against BR alone in an ongoing phase III study.

Finally, venetoclax (Venclexta) was recently found to have significant single-agent activity in MCL. What is interesting, he says, is to see combinations of venetoclax and ibrutinib together in an effort to lose the chemotherapy backbone.