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EHA 2025 | Salvage treatment strategies after covalent BTKis in Waldenström’s macroglobulinemia
Anna Maria Frustaci, MD, Niguarda Hospital, Milan, Italy, comments on the need for salvage treatment strategies after covalent BTK inhibitors (BTKis) in Waldenström’s macroglobulinemia, highlighting the unmet clinical need for effective treatments. Dr Frustaci mentions potential strategies being explored in clinical trials, such as non-covalent BTKis or BCL2 inhibitors. This interview took place at the 30th Congress of the European Hematology Association (EHA) in Milan, Italy.
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Transcript
This is a great question because the salvage treatment after covalent BTK inhibitor in Waldenström macroglobulinemia is really an unmet clinical need. We don’t have a well-known strategy to break these patients. We just know about phase one and phase two studies, so at the moment we can use a salvage treatment, non-covalent BTK inhibitors. This is supported by the BRUIN’s trial that explored patients with Waldenström, a cohort of patients we previously treated with covalent BTK inhibitors that responded well to pirtobrutinib...
This is a great question because the salvage treatment after covalent BTK inhibitor in Waldenström macroglobulinemia is really an unmet clinical need. We don’t have a well-known strategy to break these patients. We just know about phase one and phase two studies, so at the moment we can use a salvage treatment, non-covalent BTK inhibitors. This is supported by the BRUIN’s trial that explored patients with Waldenström, a cohort of patients we previously treated with covalent BTK inhibitors that responded well to pirtobrutinib. We have about 22 months of progression-free survival in the whole cohort, so including exposed and not exposed to covalent BTK inhibitor. But of course, this is an effective strategy because we know that patients that relapse with BTK mutation, covalent BTK inhibitor may respond to non-covalent BTK inhibitor. Another strategy could be the BCL2 inhibition. This was explored in a phase two study from the center of Boston with the venetoclax monotherapy but there are currently some ongoing trials also with some sonrotoclax that is a next generation BCL2 inhibitor and also this pathway could be an effective strategy for patients relapsing after covalent BTKi.
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Disclosures
Beigene, Janssen, Abbvie, AstraZeneca.
