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Dr Jia Ruan: Advances in mantle cell lymphoma

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A first-line chemo-free approach for mantle cell lymphoma

 

 

 

Clementine:

Hello! You’re on MD-FM INSIGHT, the first medical web radio. Today we’ll be devoting our "Question & Answer" program to the treatment of mantle cell lymphoma

 

 

Clementine:

Mantle cell lymphoma accounts for 6% of non-Hodgkin’s lymphoma. Managing this disease is challenging: its natural history is aggressive and CML is incurable with conventional chemotherapy. Recently, treatments have shifted to more potent chemotherapy regimens. However, many patients cannot tolerate them and new therapeutic approaches are required.

 

At the 2013 annual hematology meeting, in New Orleans, I interviewed Dr. Jia Ruan, medical oncologist at Weill Cornell Medical center, in New York. She presented the results of the first study investigating the use, in the first-line setting, of a chemotherapy-free approach combining 2 biologics: lenalidomide and rituximab.

 

Clementine:

Hello Dr. Ruan. First of all: can you tell us what was the idea behind this study…

 

Jia Ruan:

“In our practice, there are many patients who are elderly and who may not be physically fit for conventional chemotherapy. So we had experienced utilizing immune-modulatory compounds in the past but for patients with relapsed disease. We had seen very encouraging response rates and also response quality. So we wanted to take it one step further: we tried to test that particular concept which is utilizing biologics that have clinical activity in mantle cell lymphoma and then move them forward in the front line setting…”

 

Clementine:

Ok, so tell us about the biologics you are testing then, and why those…

 

Jia Ruan:

 “We proposed for this particular study to combine rituximab, which is an antibody attacking B-cells and lenalinomide, a compound which seems to have activity on the tumor cells as well as on the environment where the tumor cell reside.”

 

Clementine:

And from what I heard: there were 31 patients included with stage III/IV disease, with a mean age of 65 years old, who all received several cycles of this combination... What did you find?

 

Jia Ruan:

 “The results seem to be rather encouraging. It’s well tolerated, a majority of the patients maintained on the study, and the response rate was quite impressive: the overall response rate was over 80 percent and we had about 50 percent of patients who had a complete response and those responses are ongoing, so it seems to be rather durable.”

 

Clementine:

OK and what about on the safety side?

 

Jia Ruan:

 “It seems to be rather safe for a majority of patients who were on the study.”

 

Clementine:

Ok: “Rather safe”, what type of issues did you encounter?

 

Jia Ruan:

 “The safety issues are, I would say, they’re fairly typical and expected for anybody whose getting treatment on lenalinomide, and rituximab, but mainly lenalinomide. I believe that we see cytopenias, but most of them are asymptomatic, and can be managed with those modifications. And non-hematological toxicity are mainly fatigue, rashes and, sometimes, inflammatory syndromes, which we now call tumorfolier, this seems to happen rather early, during cycle 1 of treatment, but subsequently subside with supportive care or dose modification of medications. So I would say that, after the first couple of treatment cycles, the majority of our patients continue with their therapy with minimal symptoms.”

 

Clementine:

Well that sounds excellent. And just one point that caught me during the presentation: the efficacy of the combination improved with time didn’t it? How do you explain that?

 

Jia Ruan:

 “Well I think that probably has to do with what we do know, or do not know, about the mechanism of lenalinomide… Lenalinomide has many targets, some are on the tumor cells, others are in the microenvironment, maybe angiogenesis, or maybe lymphogenesis… And I believe some of these mechanisms may take time to realize, to remodel. Also, there might be, certainly, synergy between lenalinomide and rituximab. So, therefore, our general impression is that it’s an ongoing but slow and steady type of approach.”

 

Clementine:

OK and now, these patients are... still on treatment?

 

Jia Ruan:

 “The treatment, at present, is ongoing and I think it’s important to continue in order to maintain patients in their remission status. Because the bottom line is that I still don’t think that we know the answer if there’s a cure for mantle cell lymphoma, even with this particular regimen.”

 

Clementine:

So what’s the next step?

 

Jia Ruan:

 “Probably wait for more study to come in line, to include more patients and, perhaps, also try to study that in combination with other biologics and then to compare that to conventional chemotherapy.”

 

Clementine:

 Yes of course… Ok so what’s the take home message then?

 

Jia Ruan:

 “The take home message is that there are a variety of new options, novel agents available, for treatment of non-Hodgkin’s lymphoma, particularly mantle cell lymphoma. Therefore, it really provides a breakthrough opportunity to rethink about treatment paradigm: Do we really need initial therapy based on traditional chemotherapy? Can we consider using biologics? Particularly those that seem to be well tolerated and also have durable effect?… So I think it is an on-going debate and I think it’s a welcoming one because we do have very reasonable and good results that would allow us to continue developing that particular concept. Overall I think it’s good news for patients because there’s more options.”

 

Clementine:

This show is over. By visiting the MD-FM website, you can check out the themes of the programs we will be offering you regularly.

See you soon on MD-FM.

 

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