Our recent CLL Global Research Foundation Town Hall featured CLL Global President, Dr. William Wierda, and Dr. Alessandra Ferrajoli, from The University of Texas MD Anderson Cancer Center. Watch the full webinar.
Expert Panel:
Dr. William Wierda, President & CEO, CLL Global Research Foundation
Dr. Alessandra Ferrajoli, The University of Texas MD Anderson Cancer Center
Transcript
Jamie Forward:
So, the next one comes from Carol: My husband does respond to BTK inhibitors but has gotten AFib with ibrutinib (Imbruvica) and acalabrutinib (Calquence). Are the newer BTKs better? Dr. Wierda?
Dr. William Wierda:
Sure. So, pirtobrutinib in the randomized trial, for example, the BRUIN CLL-313 randomized trial where patients were assigned a treatment as their first treatment with pirtobrutinib (Jaypirca) versus chemoimmunotherapy, bendamustine (Treanda) plus rituximab (Rituxan), on that trial, the incidents of atrial fibrillation was the same in both of those arms. So, if you talk about BTK inhibitors, in my opinion, the risk is lowest with pirtobrutinib.
Probably next high is, and an increased risk for atrial fibrillation, although lower than ibrutinib, are the second generation BTK inhibitors, acalabrutinib and zanubrutinib (Brukinsa). And, of course, ibrutinib is the one that has really been associated with highest risk for atrial fibrillation and cardiac events. So, pirtobrutinib would be the preferred BTK inhibitor to avoid any risks or as much risk for atrial fibrillation as possible.
Dr. Alessandra Ferrajoli:
Just to comment, it also needs to be kept in mind that the expected risk for atrial fibrillation for a patient with CLL, just based on age and other conditions is not zero. There is a low risk that is common to the population with similar characteristics in terms of sex, in terms of age, in terms of presence of hypertension.
So, that has been demonstrated. But yeah, I agree with Dr. Wierda. It seems that the more selective the agents are within the BTK mechanism, the lower the risk is for atrial fibrillation.