Future directions

In the current landscape, standardized treatment algorithms still lack sufficient evidence-based guidelines required to guide optimal therapy. Obinutuzumab, which has shown efficacy in FL, is currently being tested both in combination with chlorambucil and bendamustine in current Phase III trials for MZL.131,132 However, Herold et al recently reported the results of a subset of patients in the randomized Gallium trial comparing obinutuzumab or rituximab in patients with previously untreated advanced stage MZL.133 This study did show a significant difference in PFS between arms and actually showed increased frequency and severity of AEs.133 Other investigatory trials continue to be underway looking for other efficacious novel agents.


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CONCLUSION

MZL is a relatively rare and heterogeneous malignancy of B-cells that makes dedicated clinical trials difficult to perform and for which standardized treatment regimens are unfortunately lacking. Though each subtype has a unique initial treatment strategy based on limited-stage disease characteristics, with more advanced stage disease and R/R MZL, regimens used for advanced FL are usually employed. Though smaller studies have specifically looked at chemoimmunotherapy regimens for R/R MZL, consensus evidence-based guidelines on treatment specific to MZL are lacking. A recent pivotal Phase II trial has shown that single-agent ibrutinib is both a safe and efficacious treatment for all subtypes R/R MZL. Based on this, ibrutinib is rapidly gaining popularity as an agent of choice in MZL that progresses after rituximab-based therapy. Future studies will inform about the role of single-agent ibrutinib in both treatment-naïve patients, and its role in R/R MZL in combination with other agents.

Disclosure

The authors report no conflicts of interest in this work.


Nathan M. Denlinger, Narendranath Epperla, Basem M. William

Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center (OSUCCC-James), The Ohio State University, Columbus, OH, USA 


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