Dr. Skarbnik on Selecting Between BTK Inhibitors in MCL

Alan P. Z. Skarbnik, MD, a hematologist/oncologist with Novant Health, discusses factors to consider in selecting between BTK inhibitors in mantle cell lymphoma (MCL).

Currently, ibrutinib (Imbruvica), acalabrutinib (Calquence), and zanubrutinib (Brukinsa) are approved for the treatment of patients with MCL who have received at least 1 prior line of therapy.

However, with no head-to-head data available, selecting between the 3 agents can be challenging, says Skarbnik. Moreover, all 3 agents have demonstrated similar efficacy and manageable safety profiles in patients with MCL.

Although cross-trial comparison is discouraged, the duration of response (DOR) with acalabrutinib appears to be longer compared with ibrutinib, Skarbnik says. However, patients in the acalabrutinib clinical trial were not as heavily pretreated as those in the ibrutinib trial. The median number of prior lines of therapy was 2 and 3, respectively.

Additionally, zanubrutinib has demonstrated good DOR and depth of response among patients with MCL, Skarbnik says.

Toxicity and tolerability may be key indications to guide which BTK inhibitor is best suited for a particular patient with MCL, concludes Skarbnik.