Utilizing BTK Inhibitors to Treat Patients With Chronic Lymphocytic Leukemia

At the 2023 Lymphoma, Leukemia & Myeloma Congress in New York, New York, Javier Pinilla-Ibarz, MD, PhD, Moffitt Cancer Center, Tampa, Florida, participated in a debate in which he supported the value of the role that Bruton Tyrosine Kinase (BTK) inhibitors play in treating patients with chronic lymphocytic leukemia (CLL). 

Transcript:

Hello, my name is Javier Pinilla. I'm a hematologist at the H. Lee Moffitt Cancer Center in Tampa, Florida where I am the head of the lymphoma section. I'm here at the Lymphoma, Leukemia & Myeloma Congress in New York City where I have the pleasure to be introduced in a debate, really discussing the time-limited therapies versus treatment anti-progression.

My role in my debate was to defend and to really justify why or how we [are] treating patients with CLL therapy with these new therapeutic strategies such as Bruton Tyrosine Kinase inhibitors (BTKIs) that we have many approved. During my debate presentation against my colleague from the Mayo Clinic, I discussed the fact that Bruton Tyrosine Kinase inhibitor[s] have been in the clinic for a long time. And I make parallel similarities between chronic myeloid leukemia, [another] type of chronic leukemia for which we treated until progression with tyrosine kinase inhibitor with CLL, [but] we now treat them with bruton tyrosine kinase inhibitor.

The point I'm making and the reason why I justified that it's okay to really treat these conditions with long-term therapy is because the data that is being generated for multiple phase 3 trial[s] suggests that patient[s] [can] tolerate the drug, they're on therapy, [and] they have very, very low chances to progress. And it's true that when I really discuss this topic with my colleagues who really were defending the time limited therapy, my point was that in time limited therapy, you could reach [a] very nice progression-free survival. But when you look at the type of patients who really do that, we see that the high-risk population, TP53, the L17P, unmutated IGHV patient, as soon as you stop therapy, disease biology takes place, and they start to relapse.

And I'll have to admit that these patients may still have a period of time with no therapy, which may benefit some of them. However, the concern could be that those patients may develop more aggressive disease[s] that may be harder to be treated in the future with these new therapeutic strategies. Through the presentation, I really try to establish this parallelism between CML and CLL, with which we have in both cases, multiple drugs. We have first generation [and] second generation, as we have now with the new BTKIs [that] are better tolerated for which patients really, really do much better as well. [There are] issues with long-term progression, very low rates of progression while on therapy and obviously the possibility [patients] have mutation, but at the same time, new BTKIs inhibitors [that are] almost not yet approved [for] CLL but approved [for] mantle cell lymphoma also is going to really fill this gap to continue our patients in long-term remissions. 

Obviously, discussions later went back and forth about the fact that these things may be approached for some patients [or] not. But [there is definite consideration for] the age of our patients, all the population who are chronic therapies, who are ready in other things. As soon as they really tolerate the drugs, I think it's a great approach for them. [The drugs] are convenient, [with] no need to come to the hospitals and [patients] may maintain a very good quality of life if they [are] able to tolerate the drugs very well.

Source:

Pinilla-Ibarz J. Debate: BTKi vs BCL2i: Round 2. Presented at Lymphoma, Leukemia & Myeloma Congress; October 18-21, 2023. New York, NY