Patients with Mantle Cell Lymphoma Treated With cBTKi With and Without Cytotoxic Chemotherapy
In a recent retrospective study presented at the 66th American Society of Hematology Annual Meeting & Exposition in San Diego, CA, researchers set out to determine the real-world characteristics and survival outcomes of patients with mantle cell lymphoma (MCL) treated with either covalent Bruton tyrosine kinase inhibitors (cBTKi) alone or in combination with anti-CD20 monoclonal antibodies (mAb) in the first-line setting. The results indicated that patients who received a cBTKi plus an anti-CD20 mAb had better outcomes compared with patients who received cBTKi monotherapy.
Mantle cell lymphoma is an aggressive subtype of non-Hodgkin lymphoma, but the introduction of cBTKi into the first-line (1L) treatment setting could potentially improve patient outcomes.
To determine this, researchers used the Flatiron Health database, which included 217 patients diagnosed with MCL between 2013 and 2023 who received cBTKi therapy as their initial treatment. Of these, 66% received cBTKi monotherapy, while 34% were treated with cBTKi plus an anti-CD20 mAb. The cohort had a median age of 75 years and were predominantly older, male, White patients treated in community settings. Approximately half had good performance status, and only 9% exhibited high-risk features like bulky disease or impaired renal function.
The study results indicated that patients treated with cBTKi monotherapy experienced shorter real-world progression-free survival (rwPFS) at 14.2 months and real-world overall survival (rwOS) at 30.7 months compared with those receiving cBTKi plus anti-CD20 mAb, who had extended rwPFS of 31.6 months and rwOS of 52.3 months.
These results were achieved in a population characterized by advanced age, where traditional cytotoxic chemotherapy is often avoided due to concerns about tolerability. The results also indicated limited efficacy of monotherapy in achieving durable disease control, as evidenced by 51% of patients initiating second-line therapy.
While the study results highlight the potential benefits of combination therapy with cBTKi and anti-CD20 mAb in older patients who are less likely to tolerate intensive chemotherapy, the researchers noted that more guidance on the subject is still needed.
“Patients who received a cBTKi plus an anti-CD20 mAb had better outcomes compared with patients who received cBTKi monotherapy,” the researchers concluded. “This study highlights the need for guidance in the treatment and development of tolerable and effective therapies for the 1L treatment of patients with MCL, while suggesting that the use of a cBTKi plus an anti-CD20 mAb may improve outcomes, especially for those who are older.”
Reference
Sawas A, Wadé NB, Roose J. Real-world characteristics and survival outcomes of patients with mantle cell lymphoma treated with covalent Bruton's tyrosine kinase inhibitors in first-line. Paper presented at: 66th ASH Annual Meeting & Exposition. San Diego, CA. December 7, 2024. https://ash.confex.com/ash/2024/webprogram/Paper203687.html.