Dreyling Discusses the Impact of the TRIANGLE Study

Martin Dreyling, MD, University Hospital LMU Munich, in Germany, discusses how the safety and efficacy results from the TRIANGLE study (NCT02858258) in mantle cell lymphoma (MCL) differ from prior expectations.

The TRIANGLE study sought to evaluate whether standard treatment with autologous stem-cell transplantation (ASCT) was superior to a treatment adding ibrutinib (Imbruvica), but without ASCT, in patients with MCL.

After more than 5 years of follow-up, the results from the study demonstrate significant advancements in the treatment of younger patients with MCL. Progression-free survival and overall survival were both significantly improved in the experimental arms containing ibrutinib, with a clinically meaningful benefit of approximately 10% vs the standard treatment. Additionally, rituximab maintenance, when combined with ibrutinib, continues to enhance patient outcomes, further supporting its inclusion in treatment protocols.

Regarding the role of ASCT, Dreyling says that it is no longer required for the overall patient group receiving ibrutinib-based therapy. However, approximately 10% of very high-risk patients still derive benefit from the addition of ASCT. These results underscore the progress made while highlighting areas that require personalized treatment strategies.

Transcription:

0:10 | Well, it is fair to say some of these results were somewhat expected and others were surprising. So, first of all, when it comes to the modified progression-free survival, which was the primary study aim, we somewhat expected that the addition of the targeted treatment does improve the outcome. What was somewhat a surprise is that also ibrutinib, instead of autologous stem cell transplant, still resulted in a significant improvement of progression-free survival.

0:46 | And finally, what is somewhat surprising, and that is in contrast to a number of prior studies that we could increase overall survival in the range of 10%, so 1 out of 10 patients, and that is really a major improvement, which means, essentially, whatever kind of salvage treatment you consider, you will not catch up for the advantage in first-line treatment.