Dr Shouse on AEs Associated With Targeted Therapies in FL

Geoffrey Shouse, DO, PhD, assistant professor, Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, discusses adverse effects (AEs) associated with targeted therapies used to treat patients with follicular lymphoma (FL), highlighting how he determines which patients would benefit most from these novel approaches.

AEs associated with cancer treatments vary by drug class, Shouse begins. For example, lenalidomide (Revlimid), a cereblon inhibitor, is linked to an increased risk of thrombosis, he states. To manage this, investigators assess a patient’s baseline thrombosis risk and provide preventive medication, often aspirin or blood thinners, depending on their history of thrombosis and overall risk level, Shouse states. On the other hand, BTK inhibitors, such as zanubrutinib (Brukinsa), commonly raise concerns about bleeding, irregular heart rhythms, and low blood counts, he adds.

Low blood counts are generally manageable with growth factors and prophylactic medications to prevent infections, he continues. For bleeding, Shouse says that treating oncologists should closely monitor patients, and in cases of severe bleeding, the treatment dosage may be reduced or switched altogether. Irregular heart rhythms are also monitored, and although studies indicate that patients with baseline arrhythmias may still tolerate BTK inhibitors like zanubrutinib, investigators should manage these conditions as they arise, he notes. However, if heart issues worsen, discontinuing the drug may be necessary, Shouse emphasizes.

Overall, targeted therapies for patients with FL are generally well tolerated, but the key is to consider any pre-existing conditions or toxicities, he states. For instance, patients with poorly controlled atrial fibrillation may not be ideal candidates for BTK inhibitors, and those with a history of severe bleeding episodes or multiple thromboses might not be suitable for treatments such as lenalidomide, he elucidates. It is also important to note that tailoring treatment based on individual risk factors ensures patients receive the most appropriate and safe therapy, Shouse concludes.