Dr. Shah on Treatment of Patients with p53-Mutated MCL

Bijal D. Shah, MD, medical oncologist, Moffitt Cancer Center, assistant professor of oncology, University of South Florida, discusses the treatment of patients with p53-mutated mantle cell lymphoma (MCL).

In terms of treatment with BTK inhibitors, one has to consider how it will play out with this genomically heterogeneous patient population. The patients with low-risk p53 wild-type disease respond well to treatment. This is the same subgroup that benefits from autologous stem cell transplant. On the other hand, patients with highly proliferative p53-mutant MCL are progressing very quickly on treatment. Shah adds that their survival is also exceptionally poor, around 2 months.

About 20% of these patients can be salvaged, but that leaves around 80% of this subgroup that struggles. These patients tend to progress within the first few months of taking ibrutinib (Imbruvica). Shah says this seems to open up many opportunities to use minimal residual disease as an adaptive approach to guide the addition of other drugs. He concludes that p53 and proliferative status seem to be predictive of how a patient will respond to BTK inhibition.