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SOHO 2026 | A data-driven push of BTKi to the frontline in MCL: the landmark ECHO and TRIANGLE studies
Yucai Wang, MD, PhD, Mayo Clinic, Rochester, MN, discusses how clinical trial evidence has driven the adoption of frontline Bruton’s tyrosine kinase inhibitor (BTKi)-based strategies in mantle cell lymphoma (MCL). Dr Wang highlights the landmark ECHO (NCT02972840) and TRIANGLE (NCT02858258) trials, as well as BTKi-based chemo-free approaches for patients with TP53-mutated disease, which have accelerated the integration of BTKi-based treatment into frontline treatment. This interview took place at the 14th Annual Meeting of the Society of Hematologic Oncology (SOHO 2026) in Houston, TX.
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Transcript
Mostly driven by data. You know, with the landmark randomized trials such as ECHO trial demonstrating acala-BR better than BR alone, and the TRIANGLE trial showing that when you add ibrutinib, you can probably safely omit transplant. Those have had a big push of using BTK inhibitors in the front line. So we have seen rapid changes in the practice pattern after these two trials. So I would say mostly data-driven...
Mostly driven by data. You know, with the landmark randomized trials such as ECHO trial demonstrating acala-BR better than BR alone, and the TRIANGLE trial showing that when you add ibrutinib, you can probably safely omit transplant. Those have had a big push of using BTK inhibitors in the front line. So we have seen rapid changes in the practice pattern after these two trials. So I would say mostly data-driven. And prior to those, in the United States, we do have some single-arm studies studying BTK inhibitor-based treatments, such as ibrutinib rituximab, acalabrutinib-rituximab, single-arm studies. So those probably helped with our selection of these regimens for older, frail patients too. And then most recently, not quite most recently, but more importantly, the BOVen trial with the chemo-free BTK-based therapy for TP53-based patients, although a small cohort, but the efficacy data is very, very compelling compared to historical chemo controls. So that also changed our practice for TP53-mutated patients. So I think all in all, the push of BTK to the front line is based on data.
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