2) Follow this 🧵for 0.5h 🆓CE/#CME delivered wholly by tweet–er, post! This program is supported by an unrestricted grant from Bristol Myers Squibb. Statement of accreditation & faculty disclosures at https://t.co/8oShcATovC.#MedEd #FOAMed #onctwitter @MedTweetorials
— @onc_ce (@onc_ce) December 21, 2023
4) #MCL is clinically characterized by its heterogenous behavior, with courses ranging from indolent cases that do not require tx for years to highly aggressive MCL with very limited prognosis.
— @onc_ce (@onc_ce) December 21, 2023
6) Most common manifestations of #MCL include extensive #lymphadenopathy, #fevers, night sweats, weight loss, #splenomegaly– & extranodal organ involvement-related pain. MCL often involves #GI tract, #spleen, and #bonemarrow.https://t.co/VWmdQj8SGd
— @onc_ce (@onc_ce) December 21, 2023
8) Median survival with those tx's was ~ 3y, & long-term disease-free survival was rare.
— @onc_ce (@onc_ce) December 21, 2023
🔓 https://t.co/PF8ebJsvC1
🔓 https://t.co/6DCS2BXFqF
However, with the development of #rituximab and regimens specific for this disorder, survival has improved.
10) For younger patients, a “Nordic” regimen incorporating high-dose #cytarabine has been used, either with R-CHOP-like chemotherapy or BR. See "#MCL Younger" trial at https://t.co/SPhIrYDXUN
— @onc_ce (@onc_ce) December 21, 2023
12) Regardless of which regimen was used for induction treatment, maintenance therapy with #rituximab for 2-3 years was seen to improve PFS and OS in randomized prospective trials. 🔓https://t.co/P96zFINalw and 🔓https://t.co/hZdxYBCpuH
— @onc_ce (@onc_ce) December 21, 2023
14a) In the case of patients who have disease progression on BTKi, anti-#CD19 #CAR_T cell therapy is highly effective with favorable duration of remissions.
— @onc_ce (@onc_ce) December 21, 2023
15) Important new data from #TRANSCEND-NHL were released at #ASH23 as well, notably the primary analysis results from the #MCL cohort of this Ph I seamless design study. See 🔓 https://t.co/OvvReWscGA. Congrats to @michaelwangmd for simul-pub in #JCO: 🔓 https://t.co/psAWjsg1Rp pic.twitter.com/bR9PqbcZc9
— @onc_ce (@onc_ce) December 21, 2023
16b) Studies have shown rapid, durable efficacy w/ low rates of severe #CRS & neurotox across multiple R/R B-cell malignancies.
— @onc_ce (@onc_ce) December 21, 2023
🔓 https://t.co/sOkgKKEYyd.
18a) The #MCL cohort of #TRANSCEND enrolled adults w/ #PET (+) MCL per Lugano 2014 criteria. Dx confirmed w/ cyclin D1 expression or evidence of t(11;14) by cytogenetics, fluorescence in situ hybridization, or #PCR.
— @onc_ce (@onc_ce) December 21, 2023
18c) Pts underwent #leukapheresis for manufacture of liso-cel; bridging chemotherapy was allowed during the process. Reconfirmation of #PET (+) dz was required before lymphodepleting chemotx.
— @onc_ce (@onc_ce) December 21, 2023
20a) Primary endpoints were adverse events, dose-limiting toxicities, & #ORR by independent review committee per #Lugano criteria.
— @onc_ce (@onc_ce) December 21, 2023
RESULTS:
👉 88/104 leukapheresed pts received liso-cel
👉Median (range) prior lines of tx = was 3 (1‒11); 30% had ≥5 prior lines
(cont)
20c) (cont)
— @onc_ce (@onc_ce) December 21, 2023
✔️in efficacy set (n=83; DL1+DL2), #ORR =83.1% (95% CI, 73.3%‒90.5%) & #CR rate =72.3% (61.4%‒81.6%).
✔️Median duration of response = 15.7 months (6.2‒24.0)
✔️ Median #PFS = 15.3 months (6.6‒24.9) pic.twitter.com/MRIkbBxyaF
21) Authors concluded that #Liso_cel ➡️high CR rate & deep, durable responses with low incidence of grade ≥3 CRS, neurotox, & infections in patients with heavily pretreated #MCL, including those with high-risk, aggressive disease.
— @onc_ce (@onc_ce) December 21, 2023
23a) In this Ph 3 study, #ibrutinib + #venetoclax was associated with significant improvement in terms of #PFS, #CR rates, and #TTNT compared with ibrutinib + placebo in patients with R/R #MCL. pic.twitter.com/Sjtm6C0XC4
— @onc_ce (@onc_ce) December 21, 2023
24a) #AHS23 also brought us updated data on #pirtobrutinib, a non-covalent (reversible) #BTKi inhibitor that inhibits both wild-type and C481-mutant BTK. This is an open-label, of pts w/ R/R B-cell malignancies who had received a prior covalent BTK inhibitor. pic.twitter.com/oHYrVZN7wy
— @onc_ce (@onc_ce) December 21, 2023
24c) In primary analysis cohort, pts had received median 3 prior therapies (range 1–8), majority of which were #chemotx (96.4%) & an anti-#CD20 antibody (85.7%).
— @onc_ce (@onc_ce) December 21, 2023
24e) Outcomes were similar in the efficacy analysis cohort, including #ORR = 62.9% (44.9-78.5) and 6-mo #DOR = 64.45%.
— @onc_ce (@onc_ce) December 21, 2023
Safety: from 87 pts on therapy for median 4.2 mos. Any-grade treatment-related #AEs included ⬇️ neutrophil count (40.2%) #anemia (31.0%) ⬆️bilirubin (23.0%).
24g) A 🆓 📽️from the PI is available at https://t.co/NYzBrvWxYH.
— @onc_ce (@onc_ce) December 21, 2023
25b) It's a, CAR T plus pirtobrutinib. We saw impressive new data on CAR T (#liso_cel) at #ASH23.
— @onc_ce (@onc_ce) December 21, 2023
In #TRANSCEND_MCL, what proportion of #CRS episodes on liso-cel were grade 3, 4, or 5?
26) And you're caught up! Now claim your 0.5hr 🆓CE/#CME at https://t.co/UucJAnFScj, and FOLLOW US here at @onc_ce for more #hemonc #MedEd! Thanks to @BrianHill_MDPhD.#lymphomasm #OncTwitter
— @onc_ce (@onc_ce) December 21, 2023