Dr Sotomayor on the Integration of BTK Inhibitors into the CLL Treatment Arsenal

Eduardo Sotomayor, MD, director, Cancer Institute, Tampa General Hospital, discusses the current arsenal of BTK inhibitors in chronic lymphocytic leukemia (CLL), detailing how this drug class has advanced the CLL treatment paradigm.

During an OncLive^® State of the Science Summit™ on leukemia and lymphoma, which was chaired by Sotomayor, oncologists such as Javier Pinilla, MD, PhD, MD, of the Moffitt Cancer Center, discussed the sequencing of BTK inhibitors in CLL. Expanding on this presentation, Sotomayor notes that having multiple first-generation and second-generation BTK inhibitors available for use in CLL is a positive development, offering physicians flexibility in tailoring therapy to individual patient needs.

There are currently 3 covalent BTK inhibitors approved for use in CLL, Sotomayor states. In February 2014, ibrutinib was approved by the FDA for patients with pretreated CLL and was subsequently approved as frontline therapy in 2016. In 2019, acalabrutinib received FDA approval for patients with CLL, and in 2023, zanubrutinib received FDA approval for patients with CLL or small lymphocytic lymphoma (SLL). The latest addition to the treatment arsenal in CLL is the noncovalent BTK inhibitor pirtobrutinib (Jayprica), which gained accelerated approval for adult patients with CLL or SLL who previously received 2 or more prior lines of therapy, including a BTK inhibitor and a BCL2 inhibitor, in December, 2023.

Although the efficacy of these covalent BTK inhibitors appears similar, differences in adverse effects (AEs) allow physicians to select the agent they are most comfortable with and have the most experience using, Sotomayor notes. These agents have greatly advanced the management of CLL, Sotomayor says, adding that these agents have revolutionized approaches from the previously used combination of fludarabine, bendamustine, and rituximab (Rituxan).

However, it's important to note that targeted therapies like BTK inhibitors also come with their own set of AEs, underscoring the need for careful monitoring and management of patients undergoing treatment, Sotomayor adds. Overall, the availability of multiple BTK inhibitors has transformed the landscape of CLL treatment, offering improved efficacy and tolerability compared to traditional chemotherapy regimens, he concludes.