Examining the Role of Frontline BTKi Monotherapy in CLL - Episode 3

Advice for Ibrutinib-Intolerant Patients

March 29, 2021
Jennifer R. Brown, MD, PhD

Jennifer R. Brown, MD, PhD, suggests alternative treatments for patients who experience severe adverse-events from ibrutinib.

Jennifer R. Brown, MD, PhD: My practice has been to favor using a next-generation BTK [Bruton tyrosine kinase] inhibitor initially in patients who will be at high risk for complications with ibrutinib. If a patient is started on ibrutinib and develops intolerance, there is the possibility to switch that patient from ibrutinib to the next-generation inhibitor. We do have some data, prospective data, looking at that transition for patients who are intolerant to ibrutinib to move to acalabrutinib. Only about 40% of patients experienced a recurring AE [adverse event] in that setting. It was the same or generally lower grade, and discontinuation was about 10%. It suggested that you can often sustain patients on acalabrutinib, even when they’ve been intolerant to ibrutinib.

I often will try to give patients a break, though, if they have had a good remission to ibrutinib, if they’ve been on it for a couple of years and their disease is controlled but now they have an adverse event, I like to give them time to recover if their disease is stable and then reevaluate later. Sometimes I’ll switch classes knowing that I can go back to a BTK inhibitor later.

Transcript edited for clarity.