Among elderly patients with previously untreated mantle cell lymphoma (MCL), a combination of ibrutinib with rituximab (IR) appears to be effective, according to research published in the Journal of Clinical Oncology.
The majority of patients diagnosed with MCL are considered elderly, which is defined as being older than 65 years. Age, along with performance status and number of comorbidities is predictive of clinical outcomes in this patient population.
The standard of care treatment for elderly patients with MCL is a rituximab-based chemoimmunotherapy regimen, though this strategy is linked with a high degree of toxicity. Bruton tyrosine kinase inhibitors, such as ibrutinib, have, however, shown promise in previous clinical trials. For this study, researchers evaluated the safety and efficacy of IR among elderly patients with previously untreated MCL.
Overall, 50 patients were included. The median age at baseline was 71 years (range, 65-84), 77% of patients were male sex, 98% had a performance status score by Eastern Cooperative Oncology Group criteria of 0 or 1, 94% had bone marrow involvement, and 48% had Ann Arbor disease stage IV.
The median follow-up was 45 months, during which 56% of patients discontinued treatment for a variety of reasons, including toxicity (21 patients) and disease progression (4 patients).
The best overall response rate was 96%, and 71% of patients had a complete response. Response was, furthermore, predicted by CCND1, BIRC3, BANK1, SETBP1, AXIN2, and IL2RA expression.
Median progression-free and overall survival were not reached; the 3-year progression-free and overall survival rates were 87% and 94%, respectively. No deaths were recorded during the study period. Grade 3 to 4 adverse events included atrial fibrillation (22%), fatigue (18%), diarrhea (14%), myalgias (14%), neutropenia (8%), anemia (4%), and thrombocytopenia (4%).
“Long-term follow-up and randomized studies with standard treatments are needed to further evaluate the efficacy, safety, and pattern of relapse with IR combination,” the authors wrote in their report.
Disclosure: The study author(s) declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Jain P, Zhao S, Lee HJ, et al. Ibrutinib with rituximab in first-line treatment of older patients with mantle cell lymphoma. J Clin Oncol. 2022;40(2):202-212. doi:10.1200/JCO.21.01797