Dr. Phillips on Considering Age During Treatment Selection With BTK Inhibitors in MCL

Tycel Jovelle Phillips, MD, clinical associate professor, Division of Hematology and Medical Oncology, Department of Internal Medicine, Rogel Cancer Center, Michigan Medicine, discusses the importance of considering age during treatment selection for BTK inhibitors in mantle cell lymphoma (MCL).

MCL is a disease in which the patient population is largely comprised of elderly male patients, Phillips explains. These patients often have medical comorbidities and take other medications, so they may not be particularly fit for treatment.

Treatment selection with BTK inhibitors may be affected if patients have preexisting atrial fibrillation, uncontrolled hypertension, or chronic obstructive pulmonary disease. For example, patients with atrial fibrillation or fibromyalgia are less likely to be considered for ibrutinib (Imbruvica) compared with acalabrutinib (Calquence) or zanubrutinib (Brukinsa), Phillips explains. Additionally, long-term exposure to ibrutinib may cause increased blood pressure, which needs to be taken into consideration. Conversely, patients with severe reflux should not receive acalabrutinib.

Notably, patients taking blood thinners should be considered for acalabrutinib or zanubrutinib compared with ibrutinib because the latter agent confers an increased risk of bleeding, Phillips concludes.