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Long-Term Study Results Reinforce Benefit of Acalabrutinib in First-Line MCL Treatment

By MCLA Staff ·

Compiled by MCLA Staff. Reviewed by Annie Xiao, MD, City of Hope, Duarte, CA.

At the September 9–12 Society of Hematologic Oncology (SOHO) Annual Meeting, researchers presented updated results from the large phase 3 ECHO trial showing continued benefit from adding the BTK inhibitor acalabrutinib (Calquence) to bendamustine and rituximab (BR) as an initial treatment for older adults with mantle cell lymphoma (MCL).

After approximately five years of follow-up, patients receiving acalabrutinib plus BR went a median of 72.5 months without their cancer progressing, compared with 47.8 months for patients receiving BR alone — an improvement of nearly two years for the median period that patients lived without their lymphoma worsening.

Why is this study important to you?

ECHO is a large, randomized phase 3 trial involving 598 previously untreated patients with MCL age 65 or older. Half received acalabrutinib plus BR, while the other half received BR plus a placebo. BR was given for six cycles, while acalabrutinib was taken continuously until the disease progressed or side effects required stopping treatment. Patients who responded could also receive rituximab maintenance for two years.

Earlier ECHO results showed that adding acalabrutinib improved progression-free survival (PFS) — the length of time patients live without their lymphoma getting worse. The updated results show that this benefit has continued with longer follow-up.

What are the updated results?

With a median follow-up of about five years:

  • Median PFS was 72.5 months with acalabrutinib plus BR, compared with 47.8 months with BR alone.
  • Adding acalabrutinib lowered the risk of disease progression by 32%.
  • Fewer patients in the acalabrutinib group went on to receive another MCL treatment: 11% compared with 33% in the BR-alone group.
  • The study has not yet shown a statistically significant improvement in overall survival, meaning researchers cannot yet conclude that adding acalabrutinib helps patients live longer.

Longer follow-up also revealed no significant new safety concerns. Serious or severe side effects occurred in approximately 89% of patients in both groups, while serious or severe heart-related side effects occurred in 8.1% receiving acalabrutinib plus BR and 6.1% receiving BR alone.

Takeaways

The updated ECHO results provide stronger evidence that adding acalabrutinib to BR as an initial treatment can keep MCL under control substantially longer in patients age 65 and older. The median time without disease progression was approximately six years with acalabrutinib plus BR, compared with four years with BR alone.

The results also support a broader shift in MCL treatment toward incorporating BTK inhibitors earlier rather than reserving them only for patients whose disease has returned. However, longer follow-up is needed to determine whether improved disease control ultimately translates into longer overall survival.

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