Andrew D. Zelenetz, MD, PhD, Medical Director of Quality Informatics at Memorial Sloan Kettering Cancer Center, New York, offered his thoughts on the combination of venetoclax and ibrutinib in the treatment of mantle cell lymphoma, as presented at the 2023 American Society of Hematology (ASH) Annual Meeting & Exposition.

The phase III SYMPATICO study is “an important, clearly positive trial,” he commented. “However, unfortunately, there are issues around ibrutinib access in the United States for mantle cell lymphoma,” he added, referring to the voluntary withdrawal of ibrutinib for this indication. “This has impacted our ability to use this regimen…. I’m hoping we will see the company reapply [for this indication].”

Andrew D. Zelenetz, MD, PhD

Dr. Zelenetz continued: “There have been some long-term toxicity issues raised with the combination of ibrutinib and venetoclax in CLL [chronic lymphocytic leukemia].” He pointed out that although the regimen appeared fairly well tolerated in these patients with mantle cell lymphoma, one listener specifically asked about age-related toxicity.

Dr. Zelenetz and his group presented a study at the 2023 ASH Annual Meeting & Exposition on venetoclax, obinutuzumab, and zanubrutinib in TP53-mutated mantle cell lymphoma. “This study was during COVID [the pandemic], and we did have infectious deaths, but it looks like combinations of venetoclax with acalabrutinib or zanubrutinib are somewhat better tolerated,” he suggested. That aside, in countries with access to ibrutinib and venetoclax, Dr. Zelenetz called this regimen “a good one. I think clinicians will want to use it in the United States, but they’ll substitute zanubrutinib or acalabrutinib.”

DISCLOSURE: Dr. Zelenetz reported financial relationships with SAB, AbbVie, BeiGene, Janssen, F. Hoffmann–La Roche Ltd, Gilead Sciences, Pharmacyclics, ­Lymphoma Research Foundation, Mei Pharma, BMS, and AstraZeneca.