Dr. Danilov on the Utility of BTK Inhibitors in CLL

Alexey V. Danilov, MD, PhD, associate director, Toni Stephenson Lymphoma Center and professor, Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, discusses the utility of BTK inhibitors as a treatment option for patients with chronic lymphocytic leukemia (CLL).

Acalabrutinib (Calquence) is a second-generation BTK inhibitor that was FDA approved, in part, based on results from the phase 3 ELEVATE-TN study (NCT02475681), which demonstrated a significant progression-free survival (PFS) benefit with the agent over standard chemoimmunotherapy, according to Danilov. Data from the study also indicated a PFS improvement when acalabrutinib was used in combination with obinutuzumab (Gazyva) vs when the agent was given as a monotherapy, although it was not powered to detect that difference, Danilov explains.

BTK inhibitors are an ideal option for patients who do not mind receiving indefinite therapy, and for those with renal dysfunction and bulky disease, Danilov adds. Additionally, these agents are beneficial for those who are at high risk of tumor lysis syndrome (TLS) and for whom it is difficult to frequently monitor symptoms as is required with venetoclax (Venclexta) and obinutuzumab, according to Danilov.

When utilized as a single agent, BTK inhibitors provide an all-oral option, as opposed to a combination of an oral agent and intravenous therapy, which may not be preferable to patients, Danilov says. Currently, the approved options for the frontline treatment of patients with CLL have proved to be beneficial, Danilov concludes.