ECHO: Can we expect a novel standard of care in newly diagnosed MCL?

Acalabrutinib added to bendamustine and rituximab decreased disease progression or death risks compared with BR and a placebo for mantle cell lymphoma.

MCL study: Combination therapy of bendamustine and rituximab plus acalabrutinib

The phase 3 ECHO trial (NCT02972840) randomised 598 participants over 64 years of age with newly diagnosed MCL 1:1 to BR plus acalabrutinib or BR plus placebo. The primary endpoint was progression-free survival (PFS). “Participants in the placebo arm were permitted to cross over to acalabrutinib if they had disease progression,” noted Prof. Michael Wang (University of Texas, TX, USA)1.

After a median follow-up of 45 months, PFS was improved in the acalabrutinib arm compared with the placebo arm (HR 0.73; 95% CI 0.57–0.94; P=0.016). The median PFS was 66.4 months in the acalabrutinib and 49.6 months in the placebo arm. Of note, 69% of the participants in the placebo arm received BTK inhibitors as a subsequent treatment. According to Prof. Wang, there was a positive trend in OS as well, with a hazard ratio of 0.86 (95% CI 0.65–1.13; P=0.27). “If we censor for COVID-related deaths the OS trend was even more positive (HR 0.75; 95% CI 1.04; P=0.08),” emphasised Prof. Wang.

Acalabrutinib plus BR: new standard therapy for older patients with MCL?

The safety profiles of the 2 treatment regimens did not differ substantially. Atrial fibrillation occurred in 6.1% of the participants on acalabrutinib and in 4.4% of placebo. Hypertension (12.1% vs 15.8%) and major bleeding (2.4% vs 5.4%) were slightly more common in the placebo arm, whereas infections (78.1% vs 71.0%) were more frequently reported in the acalabrutinib arm.

“The data from ECHO indicate that acalabrutinib plus BR may be a new first-line standard of care for older patients with MCL,” concluded Prof. Wang.

Medical writing support was provided by Robert van den Heuvel.

  1. Wang M, et al. Acalabrutinib plus bendamustine and rituximab in untreated mantle cell lymphoma: results from the phase 3, double-blind, placebo-controlled ECHO trial. Abstract #LB3439, EHA congress 2024, 13–16 June, Madrid, Spain.