New mixture remedy gives hope for older sufferers with mantle cell lymphoma

The part 2 trial PrE0405 met its main endpoint, reaching a whole response (CR) charge of 85% in 33 sufferers over the age of 60 with mantle cell lymphoma (MCL) who acquired bendamustine and rituximab, a regular chemo-immunotherapy remedy, together with venetoclax, which is investigational on this setting. The mix was usually well-tolerated, a notable discovering in keeping with Craig A. Portell, MD, who offered the information for PrECOG, LLC, on the sixty fifth American Society of Hematology (ASH) Assembly and Exposition in San Diego, California, and just about (Summary 733 in Session 623).

We’re inspired by the promising outcomes of research PrE0405 as a possible enchancment in first-line remedy for our older sufferers with mantle cell lymphoma.”

Dr. Craig A. Portell, lead investigator for the research and medical oncologist on the College of Virginia Complete Most cancers Heart

Mantle cell lymphoma is a type of non-Hodgkin lymphoma that extra usually impacts males and folks over age 60. Like all lymphomas, it impacts the lymphatic system, which incorporates the lymph nodes, spleen, and bone marrow.

Though mantle cell lymphoma just isn’t curable for most individuals, remedy can scale back the extent of the illness and put it into remission for years. Nonetheless, it’s a scientific problem as a result of excessive relapse charges.

“With a median age of 60 to 70 years at analysis, many sufferers with mantle cell lymphoma are ineligible for aggressive remedies,” stated Dr. Portell. “In PrE0405, we noticed an 85% full response charge from a lower-intensity remedy.”

PrE0405

This single-arm part 2 trial aimed to guage the effectiveness of bendamustine and rituximab chemo-immunotherapy together with venetoclax (BR-VEN) as first-line remedy for sufferers over 60 with mantle cell lymphoma. The first evaluation was carried out on 33 sufferers enrolled between January 2020 and March 2022 by PrECOG investigators at a number of scientific websites within the U.S. The median age of members was 71 years (vary 61 to 80), and 76% (n=25) have been male.

All sufferers had measurable or evaluable illness, outlined as a lymph node measuring >1.5 cm or a spleen malignancy of >15 cm. 9 sufferers (27%) had high-risk blastoid histology and 22 (67%) had high-risk MIPI scores. This means that sufferers enrolled have been at greater threat by these measures.

All sufferers acquired BR-VEN for six cycles (1 cycle = 28 days). Seven sufferers (21%) over age 75 acquired a decrease dose of bendamustine on the treating doctor’s discretion.

It is not uncommon amongst sufferers with mantle cell lymphoma to proceed with rituximab after preliminary remedy, and this was inspired on this trial per doctor discretion. Upkeep rituximab was administered in 19/33 sufferers (57%).

An interim evaluation was carried out after 19 sufferers enrolled to search for tumor lysis syndrome (TLS). TLS is attributable to the quick breakdown of most cancers cells, which may result in electrolyte and kidney issues. Laboratory proof of TLS was seen in 2/33 sufferers throughout Cycle 1 solely. Scientific TLS was not seen.

The first endpoint was the PET-negative full response (CR) charge on the finish of remedy, utilizing the Lugano standards. This remedy was thought of promising if ≥ 23 sufferers attained CR. An total response charge (CR and partial responses) was noticed in 97% (32/33). PET-negative bone marrow biopsies carried out on the finish of remedy confirmed a CR charge of 85% (28/33).

Therapy was usually effectively tolerated, although gastrointestinal (GI) toxicities have been widespread. Antagonistic occasions throughout remedy included lymphopenia (n=9, 27%), neutropenia (n=5, 15%), and thrombocytopenia (n=5, 15%). GI adversarial occasions of all grades have been nausea/vomiting (n=26, 79%), fatigue (n=17, 52%), and diarrhea (n=10, 30%). Toxicities of Grade ≥3 occurred in 19 sufferers (58%).

Secondary endpoints embrace adversarial occasion charges, total response charge, progression-free survival, and total survival. Testing for minimal residual illness (MRD) was carried out by next-generation sequencing on bone marrow specimens and peripheral blood samples collected on the finish of remedy.

Check with Summary 733 and Federal Document NCT03834688 for additional particulars. This research was supported by Genentech, Member of the Roche Group.