b'VA Has More Options as Treatment for Mantle Cell Lymphoma Expands Rapidlythat changed really, I think, when it be-came clear that this new class of drugs, the Bruton tyrosine kinase [BTK] in- Until recently, treatment of relapsed and hibitors,wereactiveinthisdisease,refractory mantle cell lymphoma was really Kolodziej said.The first BTK for mantle cell lymphoma,not particularly good. But that changed ibrutinib, received U.S. Food and Drug Administration approval for relapsed orreally, I think, when it became clear that this refractoryMCLin2013. Acalabrutinib was approved in 2017 and zanubrutinibnew class of drugs, the Bruton tyrosine kinase receivedacceleratedapprovalfromthe[BTK] inhibitors, were active in this disease.FDA in November 2019. These drugs are highly effective in treating relapsed and refractory mantle Michael Kolodziej, MDcell lymphoma, often for a very durable period, often with quite acceptable tox-icity, Kolodziej said. ibrutinib if the patient has a bleedingimmunomodulators,mTORs,and A team led by researchers at the VAtendency.bortezomib. Puget Sound Healthcare System foundAs a second generation BTK, zanu- CAR T is a way to go for relapsed/that 10 of 37 patients with MCL whobrutinib is thought to be more selec- refractoryMCLbutthecostistoo underwent autoSCT between 2009 andtiveintermsofnothittingasmanyhigh,Punoted.Ifputtingfinancial 2017 at the Seattle VAMC experiencedoff-target kinases as some of the otherbarriers aside, the patients own physi-progression.Thosewhorelapsedhaddrugs in its class, said Ian Flinn, MD,calconditionandpossibledonorfor median progression free survival of 1.8of the Sarah Cannon Research InstitutealloSCT are the first factors to consider. years and median overall survival fol- inNashville,TN,inadiscussiononPhysicallyfitpatientswithaproper lowing progression of just 0.7 years. 3 OncLive. The hope is that, by beingdonor always go to transplant.Notably, the three patients who sur- more selective, youre not going to haveBiTEisverypromising.Iexpect vived for more one year all received thesome of the off-target toxicities such asitwillphaseoutCAR Tinthenear BTK ibrutinib. bleeding, cardiac effects, diarrhea, rashfuture,headded.Ittakestimeto Whilepatientswhorelapsemayand other potential problems. 4 transfersciencetopractice.CART receivechemotherapyagain,theis just staging now; BiTE is actively NCCN guidelines recommend the effi- o Thern ewT herapies following.cacyoftheseagentsandoffersthemOthernewtherapiesarealsobeing1Ladha A, Zhao J, Epner, EM, Pu JJ. Mantle cell asatreatmentofchoice,Kolodzielstudied in MCL. At research and earlylymphoma and its management: where are we said. Were seeing theBTK inhibitorstriallevel,therearesomesuccessesnow? Exp Hematol Oncol. 2019;8(1):2. doi.becoming the predominant therapy. withmammaliantargetofrapamycinorg:10.1186/s40164.019.0126.0WiththreeBTKsnowavailable,(mTOR)inhibitors,butwestillhave2The Changing Treatment Landscape of B Cell Pu told U.S. Medicine that the firstproblemsfindingastrongmTORforMalignancies: MCL and CLL: NCCN Guide-choice depends on both the patientshematological malignancy, Pu said. lines and Treatment Options. AJMC.com. Jan history and comorbidities, and currentChimeric antigen receptor-engineered21, 2020.experience with that drug. BecauseT-cells (CAR T) and bi-specific T-cell3Wu A, Graf SA, Burwick N, et al. Mantle cell ibrutinib received approval first, mostengagertherapy(BiTE)aswellaslymphoma relapsed after autologous stem cell physicianshavemoreexperienceallogeneichematopoieticstemcelltransplantation: a single-center experience. Blood Res. 2020;55(1):5761. doi:10.5045/withit,itisoftenusedinitially,hetransplantation(alloSCT)areemerg- br.2020.55.1.57said,adding,.However,acalabruti- ingasoptionsforrelapseddisease,4The Changing Landscape in Mantle Cell Lym-nib has a better [adverse events] pro- often following BTKs or other newerphoma: Recent Approval of Zanubrutinib for file, and oncologists may use it beforetherapiessuchasepigeneticagents,R/R MCL. OncLive.com. February 20, 2020.2020 COMPENDIUM OF FEDERAL MEDICINE 13'