Dr. Pinilla-Ibarz on Choosing Second-line BTK Inhibitors in CLL

Javier Pinilla-Ibarz, MD, PhD, senior member, head of Lymphoma Section, Department of Malignant Hematology, Moffitt Cancer Center, discusses the factors that go into choosing the optimal second-line BTK inhibitors for patients with chronic lymphocytic leukemia (CLL).

Although second-generation BTK inhibitors generally elicit more durable responses, all BTK inhibitors, such as acalabrutinib (Calquence) and zanubrutinib (Brukinsa), have class effects, including bleeding and hypertension, Pinilla-Ibarz says. While the possibility for cardiovascular effects may make these second-generation BTK inhibitors seem suboptimal for certain high-risk patients, other drugs being investigated in CLL may still cause similar adverse effects (AEs) in longer follow-up, Pinilla-Ibarz notes.

Since AEs are a possibility with all BTK inhibitors, even well tolerated ones such as ibrutinib (Imbruvica), closely monitoring patients throughout treatment is important, Pinilla-Ibarz explains. Fortunately, patients with CLL have a variety of treatment options, and alternatives exist for those who respond poorly to certain agents, Pinilla-Ibarz concludes.