Exploring Questions Remaining for BTK Inhibitors and B-Cell Malignancies

Kami J. Maddocks, MD, associate professor of clinical internal medicine, Division of Hematology, The Ohio State University Comprehensive Cancer Center–James, discusses the use of Bruton’s tyrosine kinase (BTK) inhibitors in patients with B-cell malignancies and how that may change in the future to provide more treatment options for these patients.

BTK inhibitors are currently used as single-agent therapies and are continued indefinitely if patients are tolerating treatment and having a good response. Some questions for this type of treatment include how well it would work as a frontline therapy and if combinations of BTK inhibitors could produce deeper remissions, according to Maddocks.

Maddocks says another question is whether treatments could allow for limited therapies. This means if a patient receives multiple drugs over the course of 2 to 3 years and they are able to achieve deep remissions or minimal residual disease negative remissions, will that patient be able to stop these therapies after a shorter amount of time instead of being on treatment indefinitely? The patient stopping therapy after a while helps decrease long-term toxicity and cost. A follow-up question is whether patients could be retreated with these therapies after stopping treatment and relapsing a few years down the line.

In mantle cell lymphoma, where BTK inhibitors are used in the relapsed setting, Maddocks asks whether it could be moved up to the frontline setting to improve outcomes in those patients.

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