Older Patients With Mantle Cell Lymphoma Benefit Most From Individualized Treatment
Dr. Peter Martin
While emerging therapies for mantle cell lymphoma (MCL) continue to shape the treatment landscape, no key standard currently exists, says one expert – particularly for older patients, who benefit most from a treatment approach that has been tailored to fit them and their disease.
In an interview with CURE’s sister publication, OncLive, Peter Martin of Weill Cornell Medicine, explained how an individualized approach that takes a number of factors into consideration benefits older patients with MCL.
Regarding older patients as well, there was a similar general agreement regarding the approach but some discordance regarding some of the nuances of the therapy. I think in general there is an agreement that older patients probably can be managed less intensively. Many people suggest that [Treanda (bendamustine)] was their primary modality or chemotherapy for the front-line treatment of older patients. But that was not universally true. R-CHOP [Rituxan (rituximab), cyclophosphamide, doxorubicin hydrochloride, vincristine and prednisone] and VR-CAP [Velcade (bortezomib), Rituxan, cyclophosphamide, doxorubicin and prednisone] backbones are still reasonable for older patients and have a lot of good data supporting them.
There’s interestingly some discordance regarding the role of cytarabine in older patients. It’s clearly active in younger patients and should we be withholding it from older patients solely based on their age? In France it was interesting to learn that they still try to give it where they can. That’s maybe a little less common in the U.S. So that was interesting.
Another interesting question was regarding (Rituxan) maintenance following a (Treanda) backbone, particularly in older patients. It sounded like the majority of people were probably against it, although some people, including me, think that there may be a role for it.
It really is the same thing with older patients where we have to take into account a lot of factors and try to come up with a regimen that is going to accomplish what our goal is, which is ultimately to help people live better lives without a lot of issues related to the lymphoma. And that’s challenging in mantle cell lymphoma, maybe more so than almost any other lymphoma.