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A Patient-Centered Approach: Treatment Strategies for Progression and Intolerance in R/R CLL - Episode 4

Clinical Perspectives: 59yF with R/R CLL Experiencing BTKi Treatment-Related AE

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Panelists discuss how to manage BTK inhibitor-related adverse events including atrial fibrillation, bleeding, and gastrointestinal toxicities through dose modifications, supportive care, and potential drug switching strategies.

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    Managing BTK Inhibitor Intolerance and Adverse Events

    The case progresses to show the patient developing multiple BTK inhibitor-related toxicities on zanubrutinib, including headaches, bruising, diarrhea, dizziness, palpitations, and new-onset atrial fibrillation. These adverse events represent both common BTK inhibitor class effects and more serious complications requiring intervention.

    Management strategies for BTK inhibitor intolerance include dose reductions, treatment holds, supportive care measures, and patient education about managing side effects. While selective BTK inhibitors like zanubrutinib show lower rates of certain toxicities compared to first-generation agents, class effects including atrial fibrillation and bleeding can still occur and may require specialist consultation.

    The discussion addresses various approaches to managing intolerant patients, including switching between different covalent BTK inhibitors, transitioning to non-covalent BTK inhibitors, or considering alternative drug classes. The decision-making process must balance disease control needs with quality of life considerations, particularly in younger patients who may require long-term continuous therapy.

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