Published on July 29, 2020
Mantle Cell Lymphoma Clinical Trials Are Showing Positive Results
Transcript | MCL Clinical Trials Show Positive Results
Hello, and welcome to Patient Power. I’m Andrew Schorr. We’re visiting with a world expert in mantle cell lymphoma and that’s Dr. Peter Martin who's head of the lymphoma service at Weill Cornell in New York City. Dr. Martin, let’s talk about clinical trials, clinical research. Where are we now, for instance with transplant?
Yeah. Autologous stem cell transplant really is an interesting idea. To some degree, it's a little bit of an old-fashioned concept. That idea being that if a little bit of chemotherapy got us partway there, then a little bit more chemotherapy is going to get us more of the way there. And historically, there's some evidence to support that. In the current era, there really is a little bit less evidence to support that it really improves things that matter like probability of being around 10 and 20 years from now. And there are two major ongoing clinical trials, one in the United States, one in Europe, that are evaluating the role of autologous stem cell transplant in people with mantle cell lymphoma.
Those are two really important trials I think we would love to have those answers now. Interestingly, mantle cell lymphoma being what it is in the current era, it's likely to take several years before we actually do have those answers because when people do very well, outcomes take a long time from clinical trials. And so essentially, we're forced in the meantime to make decisions based on the best available evidence. And as I alluded to earlier, I think that it really can be individualized based on again, what we know about the person with the lymphoma, what we know about the lymphoma and what other treatment options may be available.
People in the community have been asking us to ask you your opinion of how long do you give rituximab (Rituxan) maintenance therapy?
This is a great question. There are really two clinical trials that have demonstrated an overwhelming benefit for rituximab maintenance. I mentioned one in younger people following intensive induction and autologous stem cell transplant. There, the decision was made in the clinical trial to treat people with rituximab for three years. Most people did complete three years of maintenance therapy in that trial. And so if we're practicing evidence based medicine, the answer in that context would be three years. And I also mentioned a trial in older patients. In this case, it was over age 60, who had received R-CHOP. And in that trial, participants were randomized to rituximab maintenance essentially given indefinitely or interferon, which is the same as observation. Interestingly, in some countries in Europe, they stopped maintenance after two years. And so in a non-randomized fashion, we can compare those patients who continued indefinite rituximab maintenance to those who according to their country's regulations, stopped rituximab maintenance after two years. And those who continued rituximab maintenance beyond two years, did appear to benefit from it in terms of time to next therapy progression-free survival, et cetera.
My bias in general has been, and this may evolve over time as we learn more, but I think currently my bias is that if somebody is tolerating treatment very well, is not having a lot of infections, to continue it as long as they're doing well. At the same time, I think it's important to recognize that rituximab does have some side effects, not only the hassle and cost, but also that it does predispose to some infections most importantly, sinus and pulmonary type infections, which is really potentially even more relevant now than ever in the COVID-19 pandemic. It does have some risks, but by and large, those risks I think are outweighed by the overwhelming benefit from maintenance therapy.
Dr. Martin, it sounds like just to sum up is, this is a very hopeful time for people with mantle cell and it's being personalized?
It is. And I know there's the goal of truly personalized therapy where you sequence a tumor and you design a treatment specifically for each individual. But we're not there yet, but we're definitely moving in that direction more quickly than ever before.
Okay. Dr. Peter Martin from Weill Cornell, thank you for explaining really the landscape now in mantle cell lymphoma.
I'm Andrew Schorr. Remember, knowledge can be the best medicine of all.
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