Dr. Smith on Safety Profiles of BTK Inhibitors in MCL

Sonali M. Smith, MD, Elwood V. Jensen Professor in Medicine, interim chief, Section of Hematology/Oncology, director, Lymphoma Program, University of Chicago Medicine, discusses the different safety profiles of BTK inhibitors in mantle cell lymphoma (MCL).

Three BTK inhibitors have been FDA approved for the treatment of patients with MCL who have received at least 1 prior therapy: ibrutinib (Imbruvica), acalabrutinib (Calquence), and zanubrutinib (Brukinsa), says Smith.

Ibrutinib was the first BTK inhibitor to receive regulatory approval, says Smith. The agent had a significant impact on the MCL treatment paradigm after it demonstrated a response rate of approximately 70% with a median duration of response of approximately 1.5 years in this patient population.

However, ibrutinib is also associated with increased off-target toxicities, such as myalgias, atrial fibrillation, increased risk of bleeding, and fatigue, compared with the newer-generation BTK inhibitors.

Acalabrutinib and zanubrutinib may be better tolerated without compromising efficacy for patients; however, the follow up with these agents is much shorter than that of ibrutinib, concludes Smith.