Dr. Karmali on Optimizing Maintenance Therapy in Older Patients With MCL

Reem Karmali, MD, MS, an assistant professor of medicine (hematology and oncology) at Northwestern University's Feinberg School of Medicine, discusses next steps for optimizing maintenance therapy in older patients with mantle cell lymphoma (MCL).

An analysis examining clinical outcomes and predictors of survival in older patients with MCL in the era of rituximab (Rituxan) was presented at the 2020 ASCO Virtual Scientific Meeting. With respect to the future, the big question is how to optimize maintenance approaches for older patients with the disease, says Karmali. In a trial at Northwestern University’s Feinberg School of Medicine,investigators are examining ibrutinib (Imbruvica) maintenance therapy for up to 4 years in patients of all age groups, including those who are older. Some insight may be gained regarding whether single-agentibrutinib as maintenance would be beneficial in this particular patient population, explains Karmali.

Other ongoing trials are examining therapeutic strategies specifically in older patients with MCL, adds Karmali, one of which is the phase 3 SHINE study. In this study, patients with MCL over the age of 65 are being treated with bendamustine/rituximab (Rituxan) as a backbone with or without ibrutinib. Investigators are also addressing whether ibrutinib with rituximab versus rituximab monotherapy as a maintenance strategy would be useful.

Another European trial, the phase 3 MCL R2 Elderly trial, is being conducted to see whether lenalidomide (Revlimid) is an appropriate strategy for the maintenance setting. Many ongoing trials will address optimization of maintenance approaches in elderly patients with the disease, concludes Karmali.