New Data: The Drug Ibrutinib May Help Some Younger Mantle Cell Lymphoma Patients Avoid A Stem Cell Transplant

The current approach to therapy is a combination chemotherapy and immunotherapy, called chemoimmunotherapy. Physicians use the monoclonal antibody drug, rituximab (Rituxan), and chemotherapy, followed by stem cell transplantation.

One of the most common treatments people with this cancer can expect to receive is a combination of chemotherapy drugs and other medicines, called R-CHOP. R-CHOP is a cocktail of drugs. There are five different drugs in that recipe.

The R stands for rituximab (Rituxan). It's a type of antibody therapy. Antibodies are special proteins that seek out cancer cells in your body. Rituxan targets a protein called CD20 on the surface of cancerous white blood cells called B-cells. Once it attaches to CD20, this drug alerts your immune system to go after the cancer, or it destroys the cancer itself.

The CHO in CHOP stands for three chemotherapy drugs cyclophosphamide (C), doxorubicin hydrochloride (H), and vincristine (Oncovin O). The final drug is the steroid, prednisone, which helps to bring down inflammation throughout your body.

The drug Ibrutinib (brand name Imbruvica) taken as a daily oral medication is currently approved for patients with relapsed/refractory mantle cell lymphoma and has shown to be effective.

American Society of Hematology Annual Meeting News

Some very interesting data is being presented at American Society of Hematology (ASH) Annual Meeting.

“The European study is part of the important effort in oncology to improve outcomes and reduce toxicities for our patients by using novel agents in earlier lines of therapy.” – Dr Jakub Svoboda, a medical hematologic oncologist at Penn Medicine and associate professor of medicine at the Hospital of the University of Pennsylvania, told SurvivorNet in a new and exclusively interview.

This study demonstrated that certain younger patients with mantle cell lymphoma who receive ibrutinib (Imbruvica) combined with standard first-line treatment can avoid autologous stem cell transplantation (ASCT).

“My take-home message based on the data from the plenary session by Dr. Dreyling is that ibrutinib provides benefit when added to the current treatment used in younger patients with MCL. There were no red flags in terms of the additional toxicities in this setting, probably because these were mostly fit, younger patients,” added Dr Svoboda.

Investigators set out to see if the addition of ibrutinib to the standard regimen of immunochemotherapy and ASCT improved failure-free survival rates and whether adding ibrutinib eliminated the need for transplantation. The results of the study show that ibrutinib paired with chemoimmunotherapy was as effective as chemoimmunotherapy with ASCT. The researchers also found that adding ibrutinib to standard chemoimmunotherapy plus transplant improved efficacy. They are still investigating the comparison between ibrutinib plus chemoimmunotherapy versus ibrutinib, chemoimmunotherapy, and transplant combined.

However, Dr. Jane Winter, a hematologist at the Robert H. Lurie Comprehensive Cancer Center at Northwestern University and ASH president said that additional follow-up will be required to show definitively whether ASCT is unnecessary when ibrutinib is used. "Patients and their hematologists look forward to these results in hopefully eliminating the need for auto-transplants in mantle cell lymphoma."

According to Dr. Svoboda, the follow-up is still too short to answer the big question whether using ibrutinib may eliminate the need for consolidative autologous stem cell transplant, but we may get additional information as the data matures. Dr. Svoboda concludes, “Personally, I hope that the future treatment strategies for MCL, including the frontline management, will be based on the individual biology of the tumor and that the one-size-fits-all approach will not apply for much longer.  That will allow us tailoring the therapy to be most effective while sparing patients unnecessary toxicities from overtreatment.”

The TRIANGLE study

Patients with newly diagnosed grade II-IV mantle cell lymphoma, who were less than 65 years old and suitable for high dose chemotherapy were randomized in 1:1:1 into 3 trial arms. These arms included:

• Chemoimmunotherapy (Arm A-SOC)
• Chemoimmunotherapy plus ibrutinib (A+I, I).
• Transplant was planned for patients in Arm A and A+I who responded to the chemoimmunotherapy.

Addition of ibrutinib to chemo-immunotherapy and autotransplant (A)  was superior to SOC in terms of failure free survival at 3 years. SOC failed to show superiority over ibrutinib without transplantation.

Imbruvica

It’s an oral medication that can change the way that cells work and help the body control the growth of cancer.

Imbruvica a type of cancer growth blocker called a tyrosine kinase inhibitor (TKI). Tyrosine kinase inhibitors block chemical messengers (enzymes) called tyrosine kinases. Tyrosine kinases help to send growth signals in cells, so blocking them stops the cell growing and dividing.

Side Effects

The side effects of tyrosine kinase inhibitors are usually mild and should improve with time. They can include:

• Fatigue (feeling and being sick/Tiredness)
• Headaches
• Abdominal (tummy) pain
• Swelling in the face and lower legs
• Muscle cramps/pain
• Rash
• Diarrhea

Questions to Ask Your Doctor

• Am I eligible to receive Imbruvica?
• Am I more, or less, likely to respond to this treatment?
• How will I feel during treatment?
• What are the most common side effects of it?
• What will my treatment cost? Will my treatment be covered by my medical insurance?
• Should I get a second option regarding my diagnosis?

Learn more about SurvivorNet's rigorous medical review process.

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