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Navigating Relapse and Sequencing Treatment After BTK Inhibitors in MCL

August 22, 2025
By Peter Martin, MD
News
Video

Peter Martin, MD, discusses the complexities of treating relapsed MCL after treatment with a BTK inhibitor.

Peter Martin, MD, addressed the question of how to sequence subsequent lines of therapy for patients with mantle cell lymphoma (MCL) who have experienced relapse after initial Bruton tyrosine kinase (BTK) inhibitor treatment.

Martin navigated the current treatment void, noting that the field is rapidly moving BTK inhibitors to the front line, leaving multiple questions for subsequent lines of treatment. He discussed 2 distinct scenarios for relapse and provided a thoughtful look at potential strategies, from retreatment with BTK inhibitors to the use of novel combinations.

Furthermore, he explored the emerging roles of chimeric antigen receptor (CAR) T cells and bispecific antibodies, highlighting the need for oncologists to extrapolate from existing data as the MCL treatment paradigm continues its rapid evolution.

Martin is a professor of medicine and chief of the Lymphoma Program at Weill Cornell Medicine.

Transcript:

All the data we have currently for previously treated MCL is with BTK inhibitors in [patients] who have not received their prior BTK inhibitor. As we start to move BTK inhibitors from subsequent lines of therapy into the initial line of therapy, it opens this [mass] of questions: What do you do afterward? There are a couple of different scenarios there. One is a scenario where somebody gets a BTK inhibitor, they’ve responded well, and the intention was to stop it to limit the exposure to the treatment and the [adverse] effects. We can assume that a retreatment strategy should be considered again with a BTK inhibitor that was initially successful, either alone or in combination. There are data that suggest that a BTK inhibitor plus a BCL2 inhibitor can, in some ways, be superior to a BTK inhibitor alone.

The other question, though, is what to do in the setting of somebody who has received a BTK inhibitor…and has progressed in the context of that BTK inhibitor. Right now, it’s probably a bit of a guess in an extrapolation of data. If that were to happen in a second or third line of therapy setting, we would then move on to use CAR T cells. There would certainly be a consideration of whether a bispecific antibody should factor in there. If somebody hasn’t received any chemotherapy, that’s an unknown. If somebody just gets a BTK inhibitor without chemotherapy, should there be a consideration for chemotherapy? We don’t have data there, so I don’t think I can answer that particular question. It's a good one, though.

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Two teams of lymphoma experts engage in a face-off competition, showcasing real-world updates, patient cases, and use of ASCT or CAR T-cell therapy.


Experts discuss considerations for improving the care of patients with prostate, kidney, and bladder cancer in community-based practices at World GU 2025.

Episode 13: Perspectives on Optimizing Community Care at World GU 2025

Manojkumar Bupathi, MD, MS;Benjamin Garmezy, MD;Sam S. Chang MD, MBA;Jeff Yorio, MD
September 12th 2025
Podcast

Experts discuss considerations for improving the care of patients with prostate, kidney, and bladder cancer in community-based practices at World GU 2025.


Regarding safety, treatment-related adverse effects occurred in 93% of patients, with grade 3 or 4 TRAEs occurring in 60%.

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Tim Cortese
September 21st 2025
Article

Michael Wang, MD, stated that results from this phase 2 trial were tremendous and showed that mosunetuzumab plus polatuzumab vedotin is viable in MCL.


Geraldine O’Sullivan Coyne, MD, MRCPI, PhD, discusses how the START center may expand access to novel therapies for patients who reside in a community.

START Center Aims to Bring New Cancer Treatments, Trials to the Community

Geraldine O’Sullivan Coyne, MD, MRCPI, PhD
August 25th 2025
Podcast

Geraldine O’Sullivan Coyne, MD, PhD, MRCPI, discusses how the START center may expand access to novel therapies for patients who reside in a community setting.


The second takeaway is that the type of responses and efficacy that we have seen with these combinations rival what we have in our standard of care armamentarium.

How Promising Are Immunotherapy Combos in Indolent Lymphoma?

Tim Cortese
September 12th 2025
Article

Lorenzo Falchi, MD, highlighted the most important considerations when using novel immunotherapy combination therapies for patients with indolent lymphoma.


The complete response (CR) rate was 51.4% with M-Pola vs 24.3% with R-GemOx, respectively.

What Makes M-Pola Superior to R-GemOx in Transplant-Ineligible LBCL?

Tim Cortese
September 11th 2025
Article

Results from the SUNMO trial showed that mosunetuzumab plus polatuzumab vedotin achieved a complete response rate of 51.4% in this LBCL population.

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