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SOHO 2026 | BTKi selection in R/R MCL: implications for sequencing non-covalent BTKis
Yucai Wang, MD, PhD, Mayo Clinic, Rochester, MN, discusses findings from a real-world comparative study of covalent Bruton tyrosine kinase inhibitors (BTKis) in relapsed/refractory mantle cell lymphoma (R/R MCL). Dr Wang highlights longer progression-free survival with zanubrutinib versus ibrutinib, while zanubrutinib and acalabrutinib demonstrated similar efficacy. Dr Wang explains that treatment selection between zanubrutinib and acalabrutinib should likely be driven by differences in safety profiles, and that either choice is unlikely to affect subsequent treatment with non-covalent BTKis. This interview took place at the 14th Annual Meeting of the Society of Hematologic Oncology (SOHO 2026) in Houston, TX.
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Transcript
In this study, we’ve shown that in the retrospective setting, zanubrutinib seems to be better than ibrutinib in terms of progression-free survival in mantle cell patients in a relapsed setting. It also demonstrates a trend of zanu perhaps a little bit better than acala, although not statistically significant. In the United States, we don’t have ibrutinib for the relapsed setting mantle cell lymphoma anymore because of the withdrawal of the label...
In this study, we’ve shown that in the retrospective setting, zanubrutinib seems to be better than ibrutinib in terms of progression-free survival in mantle cell patients in a relapsed setting. It also demonstrates a trend of zanu perhaps a little bit better than acala, although not statistically significant. In the United States, we don’t have ibrutinib for the relapsed setting mantle cell lymphoma anymore because of the withdrawal of the label. So it’s going to be a choice between the zanubrutinib and acalabrutinib. Without concrete data, I think both BTK inhibitors are very reasonable. Just probably a slight difference in the side effect profile in terms of hypertension, for example, favoring zanubrutinib, and then in terms of cytopenia probably favoring acalabrutinib. So I think the choice may be more driven by the side effect profile; efficacy, the two drugs are probably similar in terms of affecting downstream choices of non-covalent BTK inhibitor or other agents, I really don’t think there’s a difference in the covalent BTK inhibitor choice. In other words, whether you choose acala or zanu, down the road, all the options like pirtobrutinib and very quickly will have access to sonrotoclax too, so I think those won’t be affected by the choice between the two covalent BTK inhibitors.
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