The recent approval of the CAR T-cell therapy brexucabtagene autoleucel (Tecartus; formerly KTE-X19) has been a welcome addition to the relapsed/refractory mantle cell lymphoma (MCL) armamentarium, but with 3 BTK inhibitors also approved in the second-line setting, the optimal sequence of therapies for patients will need to be an individualized one.
“While there are likely many patients out there who are on BTK inhibitors, theoretically, the [CAR T-cell therapy] could be given even before BTK inhibitor therapy,” explained Brian T. Hill, MD, PhD.
Beyond the BTK inhibition versus CAR T-cell therapy debate, some ongoing research in MCL is devoted to de-escalating therapy for patients with minimal residual disease (MRD)–negative disease. For example, the phase 3 ECOG-ACRIN EA4151 trial (NCT03267433) is comparing overall survival outcomes in patients with MCL who are MRD-negative in first remission who undergo autologous hematopoietic stem cell transplant followed by rituximab (Rituxan) versus maintenance rituximab alone.
Hill added that the study, which he said will take years to read out, will likely have practice-changing implications and allows the status of MRD to help inform treatment decisions in MCL.
In an interview with Onoclogy Nursing News‘ sister publication, OncLive, Hill, who is director of the Lymphoid Malignancies Program and staff physician at Taussig Cancer Institute, as well as an assistant professor of Hematology and Oncology at the Cleveland Clinic, reflected on how the approval of CAR T-cell therapy has impacted clinical practice for his patients with MCL, ongoing research with practice-changing implications, and how MCL treatment has evolved during the coronavirus disease 2019 (COVID-19)