Jeremy Abramson, MD
Jeremy Abramson, MD, Director of the Jon and Jo Ann Hagler Center for Lymphoma at Massachusetts General Hospital Cancer Center and Associate Professor of Medicine at Harvard Medical School, was enthusiastic about these data.
“These important data show that ibrutinib added to bendamustine/rituximab significantly improved progression-free survival compared with bendamustine/rituximab alone. This makes ibrutinib plus bendamustine/rituximab a new and highly effective treatment option for older patients with mantle cell lymphoma. Importantly, the addition of ibrutinib is optional, and so bendamustine/rituximab alone remains an appropriate treatment consideration,” Dr. Abramson stated.
“There was no difference [between the two treatment arms] in terms of overall survival, and so these data suggest that a patient who has disease progression on upfront bendamustine/rituximab could subsequently receive ibrutinib or a different Bruton’s tyrosine kinase inhibitor at the time of relapse, with similar long-term outcomes,” he suggested.
Further Considerations
Dr. Abramson cited some considerations in making the decision about whether to include ibrutinib upfront, as follows: “The decision of whether to include ibrutinib upfront can also be informed by the toxicity profile, as patients receiving ibrutinib plus bendamustine/rituximab had significantly more atrial fibrillation than patients treated with bendamustine/rituximab alone. Further, since ibrutinib increases the risk of bleeding, the addition of ibrutinib may not be ideal for patients on anticoagulation therapy. Finally, next-generation Bruton’s tyrosine kinase inhibitors such as acalabrutinib and zanubrutinib are increasingly replacing ibrutinib in mantle cell lymphoma due to more favorable toxicity profiles, and so ultimately it will be great to have data combining these newer, safer agents with chemotherapy, or as a component of chemotherapy-free regimens.”
DISCLOSURE: Dr. Abramson has served as a consultant for AbbVie, BMS, Genentech, Genmab, Janssen, Kite Pharma, Lilly, MorphoSys, and Regeneron.
