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The potential for chemotherapy-free strategies in mantle cell lymphoma

Peter Martin, Jia Ruan and John P. Leonard

Abstract

Mantle cell lymphoma (MCL) may be one of the few cancers where multiple chemotherapy and non-chemotherapy regimens are considered as standard. Despite the significant activity of chemotherapy in the first-line setting and beyond, its limitations are reflected in the relatively poor ultimate outcomes of patients with MCL treated in the real world. Highly proliferative MCL and those with TP53 mutations tend to respond poorly despite intensive cytotoxic therapies. Patients with co-morbidities and those that are geographically isolated may not have access to the regimens that may appear most promising in clinical trials. Thoughtfully directed, non-chemotherapy agents might overcome some of the factors associated with a poor prognosis, such at TP53 mutation, and might resolve some of the challenges related to the toxicity and deliverability of standard chemotherapy regimens. Several clinical trials have already demonstrated that combinations of non-chemotherapy plus chemotherapy drugs can impact outcomes, while data with non-chemotherapy agents alone or in combination have suggested that some patients might be well suited to treatment without chemotherapy at all. However, challenges including chronic or unexpected toxicities, the rational versus practical development of combinations, and the financial acceptability of new strategies abound. The non-chemotherapy era is here, how it unfolds will depend on how we meet these challenges.

  • Submitted May 22, 2017.
  • Accepted August 24, 2017.