Dr. Martin on Potential Drug-Drug Interactions With BTK Inhibitors in MCL

Peter Martin, MD, chief, the Lymphoma Program, Meyer Cancer Center, associate professor of medicine, Weill Cornell Medicine, discusses potential drug-drug interactions with BTK inhibitors in relapsed/refractory mantle cell lymphoma (MCL).

Currently, 3 BTK inhibitors, ibrutinib (Imbruvica), acalabrutinib (Calquence), and zanubrutinib (Brukinsa), are approved to treat patients with relapsed/refractory MCL. However, without comparative data, selecting between these agents is challenging. As such, understanding potential drug-drug interactions with BTK inhibitors may inform treatment selection. For example, acalabrutinib is absorbed less efficiently in patients also receiving gastric acid–reducing agents, including proton pump inhibitors or H2 blockers, such as famotidine (Pepcid AC), says Martin. Moreover, as many patients with MCL remain on gastric acid–reducing agents for a prolonged period of time, this can become a clinically relevant interaction, Martin explains.

Additionally, azoles, which are often utilized to treat or prevent fungal infections that can occur in patients with heavily pretreated lymphomas, could interact with BTK inhibitors, says Martin. Moreover, patients receiving BTK inhibitors in combination with steroids are at an increased risk of developing fungal infections, concludes Martin.