Dr. Maddocks on Unanswered Questions With BTK Inhibitors in B-Cell Malignancies

Kami J. Maddocks, MD, an associate professor of clinical internal medicine, Division of Hematology, The Ohio State University Comprehensive Cancer Center–James, discusses unanswered questions with BTK inhibitors in B-cell malignancies.

Currently, BTK inhibitors are approved as single agents for the treatment of patients with various B-cell malignancies, including mantle cell lymphoma (MCL), chronic lymphocytic leukemia, Waldenström macroglobulinemia, and marginal zone lymphoma, Maddocks explains. Patients typically continue on BTK inhibitors indefinitely as long as they are responding to and tolerating the regimen.

In diseases such as MCL, BTK inhibitors are reserved for the relapsed/refractory setting, Maddocks says. However, bringing these agents to the frontline setting, as well as combining them with other agents, may induce deeper remissions. 

Additionally, the question remains as to whether these agents can be given in a time-limited approach where patients may stop treatment 1 or 2 years after achieving a deep, minimal residual disease-negative remission, explains Maddocks. In turn, this could potentially decrease the long-term toxicity that is associated with BTK inhibition. 

If a patient does stop therapy and has a subsequent relapse, the question regarding the utility of retreatment with BTK inhibitors remains unanswered, says Maddocks.