Dr. Phillips on Navigating Treatment Selection With BTK Inhibitors in MCL

Tycel Jovelle Phillips, MD, clinical associate professor, Division of Hematology and Oncology, Department of Internal Medicine, Rogel Cancer Center, Michigan Medicine, discusses navigating treatment selection with BTK inhibitors in mantle cell lymphoma (MCL).

The published data in the space suggest that there could be an efficacy difference when deciding between the BTK inhibitors acalabrutinib (Calquence), zanubrutinib (Brukinsa), and ibrutinib (Imbruvica), Phillips says. However, the patient populations evaluated in the clinical trials of acalabrutinib and zanubrutinib were less pretreated compared with that treated with ibrutinib. Moreover, the clinical trials utilized different criteria. In turn, this may have resulted in an underestimation of response with ibrutinib, Phillips adds.

Overall, it is widely accepted that the 3 inhibitors are equally efficacious, Phillips continues. However, data suggest there could be safety differences between the later-generation agents acalabrutinib and zanubrutinib vs ibrutinib, the former of which appear to have a more favorabletoxicity profile. As these agents have not been compared head-to-head, comparing the toxicity profiles requires cross-trial comparison, which is not preferred. However, without the direct comparisons, informed decisions are being made off available data, Phillips concludes.