Hematologic Oncology Update, Issue 1, 2016 (Video Program)Lenalidomide and rituximab (R2) as initial treatment for mantle-cell lymphoma (MCL)
1:45 minutes.
TRANSCRIPTION:
DR LEONARD: Lenalidomide/rituximab, when we’re talking about mantle-cell, lenalidomide has an approval with about a 30% response rate, give or take, in the relapsed setting as a single agent. I think many people are using it in combination with rituximab. I think it’s a very active approach. The question is, what about using it earlier in the course of the disease? We reported some data with lenalidomide/rituximab in a fairly balanced albeit small study in patients with up-front mantle-cell. We’re now out in that group of patients over 3 years, median. Most of them are still in remission, so I think it’s a very effective regimen. We’re now in that study out 5 years with some patients still in remission on therapy. So how long it’ll work remains to be seen. But it certainly is one approach. The other approach is the ECOG study, which is a 4-arm study where everyone’s getting treated with bendamustine/rituximab, and then some people have bortezomib added into the BR. And then in the maintenance, everyone gets maintenance, either rituximab alone or R2. So I think that if you look at BR followed by R, that’s a very good regimen for mantle-cell. And I would say that probably the PFS of that is going to be somewhere out between 4 and 5 years. And so if you add lenalidomide to the maintenance and add bortezomib, you may be really having quite durable remissions with that sort of approach. So we’ll see what the data show, but I think this kind of combination cocktail, which, to some degree, is what’s happening in myeloma as well, where you go from one thing to another or one maintenance after one induction, is probably where we’re heading in mantle-cell. |