A Patient-Centered Approach: Treatment Strategies for Progression and Intolerance in R/R CLL - Episode 6
Identifying BTKi Treatment Intolerance in R/R CLL
Panelists discuss how to define true BTK inhibitor intolerance versus manageable side effects and describe successful strategies for switching between covalent BTK inhibitors to maintain treatment efficacy.
Defining BTK Inhibitor Intolerance and Management Strategies
The segment provides a framework for understanding BTK inhibitor intolerance, distinguishing between high-risk toxicities requiring immediate intervention and quality-of-life issues that may be managed with supportive care. High-risk intolerances include major bleeding, CNS hemorrhage, and life-threatening arrhythmias, which typically warrant switching drug classes.
Lower-grade but persistent toxicities such as arthralgia, gastrointestinal discomfort, and chronic diarrhea can significantly impact patient quality of life. Management approaches include dose reductions, treatment holidays, and symptomatic support measures while attempting to maintain patients within the BTK inhibitor class when possible.
The discussion emphasizes that non-covalent BTK inhibitors like pirtobrutinib offer improved tolerability profiles due to reduced off-target kinase effects. Clinical experience suggests that switching from covalent to non-covalent BTK inhibitors can resolve or reduce specific intolerances while maintaining disease control, providing an important option for BTK-intolerant patients.
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