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Advances in Treating Mantle Cell Lymphoma

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Published on December 23, 2019

Key Takeaways

  • Three oral therapies approved for treating MCL are lenalidomide (Revlimid), ibrutinib (Imbruvica) and acalabrutinib (Calquence).
  • In November 2019, the FDA approved zanubrutinib (Brukinsa) for the treatment of MCL.
  • CAR T-cell therapy shows potential as a treatment option for MCL patients who are not responding to chemotherapy or targeted therapy.

“My American dream is to cure as many patients with mantle cell lymphoma as possible,” says Dr. Michael Wang, passionately discussing the advances being made in treating this rare disease. Dr. Wang, from The University of Texas MD Anderson Cancer Center, joined Patient Power at the 2019 American Society of Hematology (ASH) Annual Meeting & Exposition in Orlando, Florida. Watch as Dr. Wang discusses the evolution of treatment options for MCL and what progress is being made in clinical trials. He also explains CAR T-cell therapy—what it is, how it works and who might benefit from it.

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Transcript | Advances in Treating Mantle Cell Lymphoma

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Esther Schorr:

Hi there.  This is Esther Schorr from Orlando at ASH 2019.  I'm here with I think 25,000 hematologists and oncologists.  And we're very fortunate to have Dr. Michael Wang here again with us this year from MD Anderson in Texas.  And, Dr. Wang, thank you for being here. 

Our real interest this year is in an area that we haven't explored that much on Patient Power but would like to do more on related to mantle cell lymphoma.  So maybe could you give a little bit of an update about that disease and then what you're seeing at ASH that might be of interest to those patients in terms of treatment? 

Dr. Wang:

Yes.  As we all know—I look at you, right? As we all know there are so many—why lymphoma is so difficult to treat is because there are too many types.  One of the types is called mantle cell lymphoma.  It's a very distinct subtype of B‑cell lymphoma, but it's rare.  Because it's rare in the past the studies are not as much because there's not so many patients affected, not a huge margin, not a lot of investment, but mantle cell lymphoma is a dead lymphoma‑‑deadly. 

Oftentimes patients do not survive.  It is one of the most difficult lymphomas to treat.  

But I have good news for you because there are so much progress in mantle cell lymphoma.  First of all let me give you a little background of myself.  I came from—three years ago I came from a very small city called Weifang with 10 million people, and I went to medical school.  Thirty‑some years later I never knew that in my whole entire life is about treating this disease.  In fact, my American dream is not about a mansion, a sport car.  My American dream is to cure as many patients with mantle cell lymphoma as possible.  

So this has become my daily life, my—there's no—I have no clear time when I'm resting, when I'm—curing mantle cell lymphoma is on my mind all the time.  And I've been treating this disease for 20 years. 

I'm very, very excited to share with the patients that lymphoma, mantle cell lymphoma therapy has evolved from chemotherapy to targeted therapies.  Targeted therapies such as ibrutinib is only a pill.  The pill can have 70 percent response rate, and acalabrutinib (Calquence), another one, 80 percent response rate.  I was responsible leading these international clinical trials that led to FDA approval so that those trials are available to those patients in America, in Europe and also in Asia. 

I'm very, very you proud with what we, my team has already done, but I am especially happy for our patients because they no longer have to get an IV line and lose hair, fall down, cause infections.  So novel therapies, not only are they much less toxic, they are very, very powerful. 

Esther Schorr:

And these are oral therapies? 

Dr. Wang:

Oral therapies.  Yeah.  So there's at least three oral pills that are approved, lenalidomide (Revlimid), ibrutinib and then venetoclax (Venclexta)—sorry, acalabrutinib.  Most are recently we approved another drug called zanubrutinib (Brukinsa).  It's a BTK inhibitor. 

Esther Schorr:

So with that—that is exciting.  With that, what does a patient who is diagnosed with mantle cell lymphoma, what should they do and the questions that they should ask, because they’re now all these choices?  What's the conversation with a specialist like you? 

Dr. Wang:

First when the patient is diagnosed with mantle cell lymphoma please don't be scared.  Relax.  There are so many therapies, and the patient could stay alive for a majority of the time many years.  Therefore it is very important to seek a tertiary center because this is rare.  It is rare in the community. Practicing oncologists see one or two for their whole entire career with mantle cell lymphoma, therefore it is very difficult to get good treatment.  Therefore it's very—it's better to say to them, saying I don't mind you sending patients to me, okay?  I would like to see all those patients.  I've never say no to any patient who wants to see me. 

Esther Schorr:

So to a center of excellence where the research…

Dr. Wang:

Right.  

Esther Schorr:

…is going on, not just with a local oncologist. 

Dr. Wang:

That's right.  Absolutely, you have to have a tertiary center that's actually has the expertise in this disease.  For example, MD Anderson, Memorial Sloan Santa Barbara, Stanford, Cornell, Lee Moffitt, many, many good places.  But we welcome all patients to come to MD Anderson.  

But I'm only talking about the chemotherapy and targeted therapies.  In this ASH conference I'm going to present the CAR T-cell therapy on mantle cell lymphoma. 

Esther Schorr:

So you want to explain a little bit about CAR T? 

Dr. Wang:

Yes. 

Esther Schorr:

That would be great. 

Dr. Wang:

First of all, the CAR‑T cell, we draw a little bit of patients’ blood and you purify the T cells.  You then in the lab use a virus gene transfer to put it into the gene so that the gene gets expressed on the top of a protein called a chimeric protein called CAR.  The T cells now is armed with a CAR that can recognize and bind to the lymphoma cells.  

Esther Schorr:

Like a cruise missile. 

Dr. Wang:

Oh, my God.  It's a cruise missile.  It's a missile together with a nuclear head, whatever you call it.  But we—nuclear head is against the lymphoma. 

Esther Schorr:

Yeah, against the lymphoma.  

Dr. Wang:

Not against...

Esther Schorr:

I understand. 

Dr. Wang:

Okay.  So then we amplify those T cells (?) in treating and put it back, and the CAR will, the T cell will be finding the lymphoma cells and cure it.  

Esther Schorr:

So it doesn't cause as much damage maybe to other cells as chemotherapy might? 

Dr. Wang:

So far there's significant toxicity issues.  This therapy is in its primitive stage.  

Esther Schorr:

Not quite there. 

Dr. Wang:

It is not quite there, but it is very, very useful to the patients whose disease could not be cured by a chemotherapy or targeted therapies.  They don't have other options.  CAR‑T cell is their option, and we are getting better on CAR‑T cells very rapidly. 

So CAR T-cell therapy a mainly really good for the high‑risk patients.  The high‑risk patients, they have no other options.  They already received chemotherapy, relapsed.  They received all the targeted therapy combination, relapsed.  There's nothing left.  We offer them CAR T-cell therapy.  CAR T-cell therapy we hope the FDA will approve it very soon, and we absolutely will work to refine it to a better generation.  

Esther Schorr:

So it sounds like to me that unlike a year or two ago when we spoke with you, with mantle cell lymphoma there is hope for better treatment. 

Dr. Wang:

There is hope.  There's I think a fraction of patients who could even be cured very soon, and we would like to work so hard to increase the speed of the curability that a fraction of people would get cured. 

Esther Schorr:

Dr. Wang, I want to personally thank you for all of the patients that you treat and for other patients in the future who will benefit from your work and from your team's work.  So thank you. 

Dr. Wang:

Thank you.  It is my pleasure and I want to share the excitement on the only with you, through you, I want this new positive message to go to the community to all the patients.  

Esther Schorr:

Well, we'll make sure that happens.  This is Esther Schorr from Patient Power.  And remember, knowledge can be the best medicine of all. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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