Ibrutinib in R/R MCL

Transcript:Ian Flinn, MD: We talked about the “newer” BTK [Bruton tyrosine kinase] inhibitors in mantle cell lymphoma, but we haven’t spoken directly about ibrutinib. Ibrutinib was the first BTK inhibitor to be developed in mantle cell lymphoma and had very impressive response rates in an era when there really wasn’t anything for patients. Are you still using a lot of ibrutinib, Bijal? Why?

Bijal Shah, MD: It comes down to what Tycel and all of us have been discussing, which is its simple, once-a-day dosing. That does prove to be beneficial for some of our patients. You joked about what happens on a third day of antibiotics. I usually don’t even make it to the third day. That’s how bad I am. Forget twice per day. I can’t do once per day. I’m thinking about that for my patients. I’m thinking about what it means, both for the older patients who may be managing multiple oral medications, and for the younger patients who may still be trying to work or do other things in spite of this diagnosis, and who are trying to figure out how they balance the need for these medications and some of the [adverse] effects that come with them. I do still use ibrutinib. Right now, I’m using both of the BTK inhibitors, and I’m eager to get experience with the newer BTK inhibitors to see what advantages and disadvantages they offer.

Ian Flinn, MD: Yes. We do have longer follow-up, and some of that follow-up with ibrutinib is reassuring in the sense that, in general, the adverse event profile gets better. There are a couple of exceptions. Maybe the atrial fibrillation is not, but most of these adverse events get better over time the longer you’re on them. Nothing speaks to usage more than experience with your comfort level. You sound like you’re going to use different ones. I’m not a 1-BTK-inhibitor kind of guy.

Bijal Shah, MD: As we’ve been talking, the whole time I’ve been processing in the back of my head whether it is time for one of these prospective registry things that we could do internally within our center, or even among a couple of centers to ask, “Is there really a difference we’re going to see,” at least regarding that 6-month tolerability question. If you ask me when patients discontinue their BTK inhibitors, most of them are doing it within that early 6-month period. Whether it’s thrombocytopenia, gastrointestinal [adverse] effects, atrial fibrillation, or whatever it may be, that’s when we see the most in the way of that intolerance, so it wouldn’t take a long time to generate that kind of a question. If BeiGene or anyone else is listening and can find that out, I wouldn’t be opposed to it.

Transcript Edited for Clarity