Dr. Rule on the Next Steps for BTK Inhibitors in MCL

Simon Rule, MD, professor of hematology, University of Plymouth, discusses the next steps for ibrutinib (Imbruvica) and other BTK inhibitors in the treatment landscape of mantle cell lymphoma (MCL).

At the 2019 ASH Annual Meeting, 7.5-year follow-up data from a pooled analysis showed that ibrutinib led to more favorable responses versus chemotherapy in patients with relapsed/refractory MCL. There are also data with the combination of ibrutinib and venetoclax (Venclexta) in the relapsed/refractory setting.

The data that Rule presented at the meeting showed that ibrutinib led to high response rates in asymptomatic patients. As such, Rule believes the next step will be to move ibrutinib and other BTK inhibitors into earlier lines of treatment.

Several trials are evaluating the use of ibrutinib in the frontline setting. One such trial in the United Kingdom is evaluating the combination of ibrutinib and rituximab (Rituxan) versus chemotherapy in older patients. Moreover, an ongoing trial is evaluating ibrutinib plus venetoclax and obinutuzumab (Gazyva). To date, 14 out of 15 patients had minimal residual disease—negative complete remissions. With further study, chemotherapy may not be necessary in the up-front setting, concludes Rule.