SAN DIEGO — The addition of intermediate-dose cytarabine to first-line bendamustine–rituximab yielded a 91% response rate, which is “essentially unprecedented” for older patients with mantle cell lymphoma, Peter Martin, MD, associate professor of medicine in the division of hematology/oncology at Weill Cornell Medicine and New York-Presbyterian, told HemOnc Today at the ASH Annual Meeting and Exposition.
A number of groups are looking at various combinations of bendamustine and rituximab (Rituxan; Genentech, Biogen) — which increasingly has become the standard of care for first-line therapy —plus other agents to improve efficacy in this setting, Martin said.
The Fondazione Italiana Linfomi evaluated the addition of intermediate-dose cytarabine to these two drugs, or RBAC500. They evaluated an intermediate-level dose because results of a previous study at a higher dose led to high rates of toxicity.
“Importantly, this was a phase 2 trial, not a phase 3 trial, and it’s very challenging to change the standard of care on the basis of a phase 2 trial,” Martin said. “We’ll hopefully be seeing a phase 3 trial of RBAC500 compared with bendamustine–rituximab alone.”
Data from the work of other groups assessing different drugs added to bendamustine–rituximab are also likely to emerge, Martin said.
“At some point in the next 5 to 10 years, we will have a number of bendamustine–rituximab plus drug X combinations that show that they are active, and it will be interesting from the clinician’s perspective to choose a regimen that seems to fit the patient best, and it will be interesting from an investigator’s perspective to choose the regimens that look the most promising and move those forward into phase 3 trials,” he said. – by Alexandra Todak