Info
rr-rx-mzl
- General approach:
- Treat w/ nonoverlapping combination regimens + anti-CD20 (if >6 mos since last exposure)
- (benda + R/obinituzumab, R-CHOP, R-CVP, len + R) or BTKi
- Ibrutinib (BTKi) w/ ORR 48%, PFS 14.2 mos in phase II trial,
- likely due to MZL dependence on B-cell receptor signaling (Blood 2017;129:2224; Blood Adv 2020;4:5773)
| Metric | Overall | Prior RTX | Prior RTX-CIT | Extranodal | Nodal | Splenic |
|---|---|---|---|---|---|---|
| ORR (Overall Response Rate) | 58% 六成 | 81% 八成 | 51% 五成 | 63% | 47% | 62% |
| Median DOR (Months) | 27.6 (95% CI: 12.1 – NE) | Not reached (95% CI: 12.2 – NE) | 12.4 (95% CI: 2.8 – NE) | - | - | - |
| Median PFS (Months) | 15.7 (95% CI: 12.2 – 30.4) | 30.4 (95% CI: 22.1 – NE) | 13.8 (95% CI: 8.3 – 22.5) | - | - | - |
| Median OS (Months) | Not reached (95% CI: NE – NE) | Not reached (95% CI: 30.3 – NE) | Not reached (95% CI: NE – NE) | - | - | - |
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Ibrutinib shows long-term safety and effectiveness in relapsed/refractory MZL.
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Patients with only prior RTX treatment had better outcomes than those who also received chemotherapy.
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Findings support ibrutinib use regardless of MZL subtype.
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PI3K inhibitors: Copanlisib, duvelisib, idelalisib, umbralisib (dual PI3K∂/CK1ε). Umbralisib is FDA approved for MZL (ASH 2020;Abs 623)