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COMy 2025 | Advice for managing adverse events associated with BTK inhibitors in patients with Waldenström’s
Steven Treon, MD, PhD, FRCP, Dana-Farber Cancer Institute, Boston, MA, discusses strategies for managing adverse events associated with BTK inhibitor treatment in patients with Waldenström’s macroglobulinemia (WM). Dr Treon highlights that dose reduction of ibrutinib alleviates most side effects, excluding atrial fibrillation. He notes that in patients who experience atrial fibrillation, switching to zanubrutinib is likely an appropriate strategy. With the emergence of the non-covalent BTK inhibitor pirtobrutinib in the WM space, Dr Treon highlights that physicians now have a greater number of options as alternatives in cases of intolerance or resistance. This interview took place at the 11th World Congress on Controversies in Multiple Myeloma (COMy) congress in Paris, France.
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Transcript
Yeah, I think it is important for physicians to recognize that we have choices. There were two really good studies which were recently reported around dealing with intolerance to BTK inhibitors. Recognize a couple of things that, with ibrutinib you can dose reduce and most of the side effects will get better, if not go away, except atrial fibrillation. And that’s really an important outcome of the study by Shayna Sarosiek that was performed at our institution...
Yeah, I think it is important for physicians to recognize that we have choices. There were two really good studies which were recently reported around dealing with intolerance to BTK inhibitors. Recognize a couple of things that, with ibrutinib you can dose reduce and most of the side effects will get better, if not go away, except atrial fibrillation. And that’s really an important outcome of the study by Shayna Sarosiek that was performed at our institution. Out of 10 patients who were on a very large cohort of patients who got atrial fibrillation, nine still had recurrence of their atrial fibrillation even with dose reduction. So if the complication is atrial fibrillation, the best option there is to go to zanubrutinib. And we learned from the NICE study that Mazyar Shadman performed that a switch over to zanubrutinib, actually, guess what? Nine out of ten patients did not have recurrence of their atrial fibrillation. So I think it is really important to keep in mind that we do have options. We also have now pirtobrutinib, which is also entering in the mainstream of caring for patients with Waldenström’s. But as we sort of levy out side effects, intolerance, as well as resistance to covalent BTK inhibitors, it is really important for our colleagues to recognize that we now have expanding options for use.
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