BTK Inhibitors: Real-World Insights on Patient Management and Therapy Selection

Published: Saturday, Sep 29, 2018
Nathan Fowler, MD

Nathan Fowler, MD
BTK inhibitors have evolved into a more prominent role in the treatment paradigm of mantle cell lymphoma (MCL) and other B-cell malignancies. However, work remains to completely refine this class of agents for patients, particularly in terms of toxicity.

, Fowler, a medical oncologist in the Department of Lymphoma and Myeloma at The University of Texas MD Anderson Cancer Center, discussed the use of BTK inhibitors in B-cell malignancies.

OncLive®: How would you characterize the role of the BTK inhibitor class among the evolving treatment landscape for B-cell malignancies?

Fowler: What we are seeing now and what we will likely continue to see is a shift away from traditional combination chemotherapy regimens, not only in the relapse setting but also in the front-line. There are several ongoing clinical trials evaluating BTK inhibitors, alone or in combination, as initial treatment for MCL. In the coming years, we are going to see more trials, not only in elderly or infirm populations, but also in younger patients, in [whom] we are using BTK inhibitors in combination with other agents, such as venetoclax, targeted small molecular inhibitors, or monoclonal antibodies.

These agents are still fairly new, and the enduring benefit and toxicity is still unknown with several drugs. CLL is a chronic disease, and several emerging drugs are potentially prescribed life-long, so clearly it is essential to understand the long-term adverse effects and financial toxicities of prolonged treatment.

Can you discuss key differences between the available BTK inhibitors, both in terms of efficacy and safety/tolerability?

The availability of multiple agents not only allows physicians to tailor therapy based on a patient’s prior medical history, but also to their willingness to accept a given risk profile. The availability of multiple agents also allows us to potentially switch these drugs if a patient develops a adverse effect that’s unique to that drug. If a patient receiving ibrutinib and has atrial fibrillation, switching to another drug in the same class could have potential benefit.
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