Dr. O'Connor on Treatment Options Following Ibrutinib Progression in MCL

Owen O'Connor, MD, PhD, professor of medicine and experimental therapeutics, director of the Center for Lymphoid Malignancies, Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center, discusses treatment options following progression on ibrutinib (Imbruvica) for patients with mantle cell lymphoma (MCL).

It depends in what line of therapy the patient was receiving ibrutinib, the kinetics of their disease growth, and the symptoms associated with the disease. According to O’Connor, if lenalidomide (Revlimid) has not been used, that is a viable option since there has been success with that regimen.

In the study that led to the FDA approval of lenalidomide, patients received 25 mg for 3 out of 4 weeks. However, there is an additional study that is investigating lenalidomide in combination with rituximab (Rituxan) which used a lower dose of 20 mg without that break. This lower dose combination showed a high rate of complete responses and patients were able to achieve minimal residual disease (MRD) negativity with durable remissions beyond 4 years. Additionally, the combination has had less toxicity, says O’Connor.