[ Inglês] Mantle Cell Lymphoma News From ASH 2018: Treatment Research Updates

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Topics include: Treatments and Understanding

On-site in San Diego at the 2018 American Society of Hematology (ASH) annual meeting, Patient Power founder Andrew Schorr is joined by renowned expert Dr. Peter Martin to discuss highlights in mantle cell lymphoma treatment news. Are doctors moving away from chemotherapy as a frontline therapy? Dr. Martin gives an update on clinical trial research, currently approved therapies for mantle cell lymphoma and treatment strategies for pre- and post-transplant and maintenance settings. Watch now to find out more.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Hello.  Welcome to Patient Power.  On location in San Diego at the American Society of Hematology meeting I'm Andrew Schorr.  I'm with a lymphoma specialist from Weill Cornell Medicine in New York City, Dr. Peter Martin.  Dr. Martin, I wanted to talk to you about mantle cell lymphoma.  So things are changing.  So tell us about that. 

Dr. Martin:

Yeah.  Mantle cell lymphoma definitely is changing.  Historically, it has been among of more complicated lymphomas to treat, I would say.  It's a pretty heterogeneous kind of lymphoma where some people present with a fairly slow-growing or indolent form, and other people present with a more aggressive form.  I think we're learning more and more about the biological heterogeneity that underpins mantle cell lymphoma. 

And every year I come to ASH, and I'm always looking for new treatments that are becoming available, and I think we're seeing hints that some of those new treatments are moving more and more into the clinic.  We now have two BTK inhibitors from data.  Last year, we saw more data from a new BTK inhibitor, the Beijing compounds and zanabrutinib that was presented a couple of days ago and looks very active in mantle cell lymphoma.  I think having more drugs available even if they're similar is great, because then you have different efficacy and tolerability profiles. 

We're also learning a little bit more about what can be done in the post-transplant setting with different kind of maintenance.  We saw data with long-term follow-up from a North American study presented by Laurie Kaplan with bortezomib (Velcade) maintenance that may have a role in certain settings, although it has some positives and some negatives.  Yesterday we saw data from a large Italian study looking at lenalidomide maintenance, post-transplant setting, and that clearly has an impact on the durability of response.  Again some positives, some negatives. 

And the interesting thing I think about being a mantle cell lymphoma doctor is trying to put all of this massive amount of information together.  And so I feel my job is sort of trying to stay up to date with all of the latest data, learning as much as I can about lymphoma for a specific person, learning as much as I can about that specific person's situation and trying to put all of that data together.  And so there's no real cookbook.  There probably never was, and now more than ever there's no single cookbook.  It's a matter of trying to come up with the right solution for every specific scenario. 

Andrew Schorr:

So you mentioned the BTK inhibitors, you have acalabrutinib (Calquence), ibrutinib (Imbrvica), others even probably in development, and then you mentioned some myeloma drugs like lenalidomide (Revlimid).  So are we moving away from a chemo approach? 

Dr. Martin:

So the question of chemotherapy and intensity of chemotherapy is one that's been of interest for quite some time.  Jia Ruan from Cornell a couple of years ago, a few years ago now, presented data with a non-chemotherapy treatment in the frontline setting of mantle cell lymphoma, updated at this meeting last year and then published it in Blood just a couple of months ago showing that lenalidomide plus rituximab (Rituxan) can be surprisingly, strikingly effective as frontline therapy for some people with mantle cell lymphoma.  And so she is designing a new trial, and hopefully later this year, in a couple of months, we'll have a new trial based on that combination. 

And I think—and you know, I think there more and more is interest in that kind of approach for some people with mantle cell lymphoma, and so the questions will be again pros, cons, picking the right people and trying to maximize efficacy while minimizing issues or toxicity issues. 

Andrew Schorr:

So I would say and I guess you'd agree as a specialist in New York City, we're talking about a more rare condition.  So for family members and patient watching checking in with a specialist such as yourself would be important, because this is a moving target and now you have subtypes of people with mantle cell. 

Dr. Martin:

Yeah, subtypes and subtypes and subtypes.  You know, I think most people with mantle cell lymphoma can be managed effectively in their community setting.  Not everybody needs to be in an academic center 100 percent of the time, right?  That's neither realistic nor is it necessary.  That said, I think that a lot of us that work in academic settings recognize that we can add value to people's treatment oftentimes.  And it doesn't mean we have to be in charge of the whole thing, but I think we're happy to work with people. 

So what you say, I think checking in is probably of value, right?  When you have a diagnosis check-in, and let's come up with a plan.  Maybe you get treated somewhere else but then come back.  You know, there are going to be forks in the road, and I think those are the opportunities where we have a potential to offer value—whether that's through a new treatment or whether that's just guiding treatment that's done somewhere else. 

Andrew Schorr:

Okay.  Great points for all of the family members and patients as consumers.  Take more control of this.  Ask questions and see should your community doctor check in with a university academic center who is a subspecialist like Dr. Martin and have a plan that you all feel comfortable with.  Dr. Peter Martin, thank you so much for being with us.  Thanks for your devotion to patients. 

Dr. Martin:

Thank you. 

Andrew Schorr:

Andrew Schorr on location in San Diego.  Remember, knowledge can be the best medicine of all.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on December 21, 2018