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ASH 2024 | Targeting BTK to treat CLL: covalent versus non-covalent inhibitors
Nirav Niranjan Shah, MD, Medical College of Wisconsin, Milwaukee, WI, comments on the benefits of BTK inhibitors (BTKis) in the treatment of chronic lymphocytic leukemia (CLL), stating that each class of inhibitors is showing promise. Dr Shah highlights that the availability of multiple oral therapies, including covalent, non-covalent, and BTK degraders, provides patients with options and allows them to progress to more effective treatments. He notes that the current standard of care is to give a covalent BTKi first, but there is ongoing research to investigate if non-covalent BTKis are more effective. This interview took place at the 66th ASH Annual Meeting and Exposition, held in San Diego, CA.
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Transcript (AI-generated)
There’s lots of BTK inhibitors under development, but the good news is that each class is looking maybe a little bit more promising than the last. So right now, I think the current standard of care is a covalent BTK inhibitor, and when that progresses, you can do a non-covalent BTK inhibitor, and when that progresses, potentially these BTK degraders, again, those are only available on a clinical trial...
There’s lots of BTK inhibitors under development, but the good news is that each class is looking maybe a little bit more promising than the last. So right now, I think the current standard of care is a covalent BTK inhibitor, and when that progresses, you can do a non-covalent BTK inhibitor, and when that progresses, potentially these BTK degraders, again, those are only available on a clinical trial. All of these drugs are going to move up and the question is going to become is it better to give your best drug first and so there are ongoing trials trying to tease that out to understand is a non-covalent going to lead to better outcomes than a covalent and and one day I’m sure we’ll see trials with degraders. For the time being, I think having all of these are great because they work after each other. And so for patients it means that they can go from one oral therapy to another oral therapy to another oral therapy. And the good news is as we talked about the Nurix clinical trial and pirtobrutinib, additionally these have been generally the newer generation drugs are not only efficacious but very well tolerated. And so how that plays out we’ll see as trials mature over the next five to 10 years. But for the time being, I think we have lots of good options and for patients, I think it serves an important clinical need.
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Disclosures
Miltenyi Biomedicine, Lilly Oncology: Research Funding; Gilead-Kite, BMS-Juno, Miltenyi, Lilly Onclogy, Novartis, Seattle Genetics, Janssen, Abbvie, Cargo, Beigene, Galapagos, AstraZeneca: Consultancy, Honoraria; Tundra Therapeutics: Current holder of stock options in a privately-held company.
