Dr. Wang on Toxicity Profiles of Ibrutinib, Acalabrutinib, and Zanubrutinib in MCL

Michael Wang, MD, professor in the Department of Lymphoma and Myeloma at The University of Texas MD Anderson Cancer Center, discusses the toxicity profiles of the BTK inhibitors ibrutinib (Imbruvica), acalabrutinib (Calquence), and zanubrutinib (BGB-3111) in mantle cell lymphoma (MCL).

These agents have shown comparable efficacy, says Wang. However, their safety profiles may factor into choosing which drug to select in the clinic.

Ibrutinib is associated with the greatest toxicity, and may lead to atrial fibrillation, infection, muscle spasms, and rash, explains Wang. Conversely, acalabrutinib is more tolerable with the most common side effect being headaches.

In 2019, the FDA granted a priority review designation to a new drug application for zanubrutinib for patients who have received at least 1 prior line of therapy. The designation was based on pooled data from phase I/II trials. However, Wang highlights that among the 3 BTK inhibitors, zanubrutinib has had the least follow-up time.