Dr Islam on Clinical Decisions Regarding BTK Inhibitor Use in MCL and CLL

Prioty Islam, MD, MSc, attending physician, medical oncologist, Leukemia, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, discusses the importance of shared decision making between patients and clinicians when selecting among available BTK inhibitors in the treatment of chronic lymphocytic leukemia (CLL) or mantle cell lymphoma (MCL).

BTK inhibitors represent a safe and well-tolerated treatment approach for patientswith CLL and MCL—even for those with high-risk disease, Islam begins. Patients with poor risk markers or relapsed/refractory MCL now have a beneficial option, as these agents are inducing significant responses with improved quality of life, she explains.Notably, BTK inhibitors have been approved across all lines of therapy in CLL, Islam says, adding that in MCL, these agents are appropriate for use in the relapsed/refractory setting.

For example, FDA-approved BTK inhibitors in CLL include ibrutinib (Imbruvica), zanubrutinib (Brukinsa), and acalabrutinib (Calquence), and are supported by data from the phase 3 RESONATE-2 (NCT01722487), ALPINE (NCT03734016), and ELEVATE-TN (NCT02475681) trials, respectively. Current FDA-approved BTK inhibitors in MCL include ibrutinib, acalabrutinib, zanubrutinib, and pirtobrutinib (Jaypirca).

BTK inhibitor selection should be a shared decision between the patient and the clinician, according to Islam. Each BTK inhibitor has its own toxicity profile, she notes. Arrythmia, bleeding risk, and hypertension are among some of the most common adverse effects (AEs) that are often experienced with BTK inhibition, Islam says.Reviewing the toxicity profiles and dosing schedules of these agents with patients prior to treatment is vital, Islam concludes.

Clinicians referring a patient to MSK can do so by visiting msk.org/refer, emailing referapatient@mskcc.org, or by calling 833-315-2722.