Dr Sekeres on the Impact of BTK Inhibitors on Approaches to CLL Management

Mikkael A. Sekeres, MD, professor of medicine, chief, Division of Hematology, Leukemia Section, Sylvester Comprehensive Cancer Center, University of Miami Health System, discusses how the emergence of BTK inhibitors have shifted approaches to the management of chronic lymphocytic leukemia (CLL).

The CLL treatment paradigm has undergone significant advancements, ushering in an era where chemotherapy is no longer the primary therapeutic approach, Sekeres begins. Presentations from the 2023 ASH Annual Meeting have showcased the superiority of BTK inhibitor-based therapy over traditional chemotherapy regimens like fludarabine, cyclophosphamide, and rituximab (Rituxan; FCR) for patients with CLL and other lymphoid malignancies, he reports. In one presentation, patients receiving BTK inhibitor-based therapy demonstrated a survival advantage without the downstream consequences associated with chemotherapy, Sekeres details.

As a specialist in myelodysplastic syndromes, Sekeres states that he has observed a shift patient’s with CLL in the clinic. Historically, many patients with CLL developed therapy-related MDS as a result of cytotoxic chemotherapy used to treat their CLL, he says. However, with the adoption of non-traditional cytotoxic chemotherapy-based approaches centered around BTK inhibitors, the incidence of therapy-related MDS has decreased. This shift represents a positive development for patients, as they are now benefiting from more targeted and less toxic treatment strategies, Sekeres explains.

Pirtobrutinib (Jaypirca), the latest addition to the BTK inhibitor arsenal, has showcased significant efficacy in patients who have received prior BTK inhibitors, Sekeres continues. The success of pirtobrutinib has prompted investigations into its use in upfront settings and in combination therapies, potentially further expanding treatment options for patients with CLL, he adds.

Overall, these advancements in CLL treatment signify a paradigm shift towards more effective and less toxic therapies, ultimately improving outcomes and quality of life for patients, Sekeres concludes. The evolution of BTK inhibitors and their integration into frontline and combination regimens hold promise for continued progress in CLL management.