A chemotherapy-free approach combining ibrutinib-rituximab (IR) has outperformed standard chemotherapy regimens in treating older patients with newly-diagnosed mantle cell lymphoma (MCL), according to findings from the ENRICH trial presented at the 66th American Society of Hematology Annual Meeting. The study compared IR against two common chemotherapy-based regimens – bendamustine plus rituximab (BR) and R-CHOP (rituximab, doxorubicin, vincristine, and prednisolone). Researchers randomized 397 patients, with a median age of 74, to receive either IR or one of the chemotherapy regimens.

The results revealed a progression-free survival (PFS) benefit for the IR group, with a hazard ratio (HR) of 0.69, (95% CI 0.52-0.90, p=0.003), median PFS 65.3 vs 42.4 months, respectively. Among the chemotherapy options, IR performed particularly well against R-CHOP and and showed similar effectiveness to the BR regimen. The median PFS for the IR group was not reached, whereas the R-CHOP group had a median PFS of 26.6 months (HR=0.37; 95% CI 0.22-0.62). In the IR/BR parallel comparison, the median PFS was 65.3 months for IR and 50.5 months for BR (HR=0.91; 95% CI 0.66-1.25). The five-year overall survival rate was 57.7% in the IR group and 54.5% in the R-chemo group (HR=0.87; 95% CI 0.64-1.18). 

Tolerability was another key advantage of IR. Patients receiving IR experienced fewer severe hematologic side effects (16.7% vs. 50% with R-CHOP) and reported better quality-of-life scores during treatment. However, the IR group had a higher incidence of atrial fibrillation (6.6% vs. 0.5% with chemotherapy). Researchers reported that quality-of-life scores were higher at mid-treatment in the IR group compared to the R-chemo group.

This study is the first to demonstrate that a non-chemotherapy approach is more effective than chemotherapy as a first-line treatment for lymphoma. The findings indicate that IR is an effective first-line treatment for older patients with MCL, particularly those with less aggressive disease. The study also reports poorer outcomes with R-CHOP compared to other regimens, which could influence its future use.

Reference

Lewis DJ, Jerkeman M, Sorrell L, et al. Ibrutinib-rituximab is superior to rituximab-chemotherapy in previously untreated older mantle cell lymphoma patients: results from the international randomised controlled trial, Enrich. Abstract 235. Presented at the 66th American Society of Hematology Annual Meeting and Exposition; December 7, 2024; San Diego, California.

 

Disclosure: This article was created by the touchHAEMATOLOGY team utilizing AI as an editorial tool (ChatGPT (GPT-4o) [Large language model]. https://chat.openai.com/chat.) The content was developed and edited by human editors. No funding was received in the publication of this article.

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