Dr. Matasar:
Hi. I'm Dr. Matt Matasar. I'm the Chief of Blood Disorders at the Rutgers Cancer Institute of New Jersey, in partnership with RWJBarnabas Health.
Graphic: One of the major trials being talked about at ASH 2023 is SYMPATICO. What can you tell us about this trial and its results?
Dr. Matasar:
The SYMPATICO trial is data we've been waiting for, and it's nice to see them here in the flesh. This is a trial evaluating new treatments for patients with mantle cell lymphoma, who've had their disease come back after one or more prior treatments. A standard approach in this disease has been to use the medicine, ibrutinib (Imbruvica), which is a pill-based treatment called a BTK inhibitor. It's a pill that's taken daily and continuously, as long as it's working, and not causing bad side effects. This has been a standard approach.
There are other medicines that we can use in this setting as well, however, and one is a medicine called venetoclax (Venclexta). And the SYMPATICO trial asked the question, when you combine ibrutinib and venetoclax for two years, and then go back to taking ibrutinib all by its lonesome, is that a better approach for patients than just doing ibrutinib alone that whole time? And "better" means, does it work longer and keep the disease from growing back more quickly?
The answer appears to be "yes." The data from SYMPATICO suggests that there is an improvement in disease control when you use the two medicines together, compared to when you just use ibrutinib all by itself. This is an important finding and potentially, practice-changing.
Graphic: Which MCL patients will this affect?
Dr. Matasar:
This is a program that will affect patients who've had their mantle cell lymphoma come back after one or more prior treatments. It's an open question of how exactly we, as doctors and oncologists, will use these data. Because ibrutinib, which is the pill that's in both of those treatment arms in this trial, is a BTK inhibitor, it's not the one that we most commonly use. Other medicines in that family have become more popular since the SYMPATICO trial was opened and designed. So how we're going to use these data is a little bit unclear, but it clearly shows us a way forward in the field of caring for people with mantle cell lymphoma, which is that combination treatment, using two different medicines together in this type of situation, can be beneficial.
Graphic: Why is this only for relapsed patients? Can this help recently diagnosed patients?
Dr. Matasar:
This is an approach that was tested in this context in patients who've been failed by prior treatments. We don't tend to use ibrutinib or medicines like it, as the first and only treatment because we have other treatments that have been better-proven in that setting to have longer, more durable, and more long-lasting results. Because of that, this is really a treatment that is not yet ready for prime time as the first treatment for this illness.
Graphic: Which patients should be having conversations with their doctors about this new treatment?
Dr. Matasar:
So anybody who's had their mantle cell lymphoma come back after other treatments, and is talking with their oncologist about what their next step is to regain disease control, this is a good study to be asking about, and getting your oncologist's take on what they think about the data, how they relate to you, and is this a good choice for you?
