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BTK Inhibitors for CLL: International Consensus for Managing Cardiovascular Risk

By: Joshua Swore, PhD
Posted: Thursday, September 15, 2022

Because of the growing concern about the cardiovascular risks associated with Bruton’s tyrosine kinase (BTK) inhibitors—specifically, ibrutinib—a panel of international experts in chronic lymphocytic leukemia (CLL) have published a set of evidence-based consensus recommendations for hematologists and oncologists in the journal Blood Advances. “The recommendations presented here take into account the available phase III data for BTK [inhibitors] to promote their safe and effective use,” said Farrukh T. Awan, MD, of The University of Texas Southwestern Medical Center, Dallas, and colleagues. “Optimizing heart failure, ventricular arrhythmia, and [hypertension] control will likely improve tolerance and maintenance of BTK [inhibitor] therapy.”

The panel was composed of 12 physicians with backgrounds in hematology, oncology, and cardio-oncology. Using published, peer-reviewed literature collected via PubMed, the committee discussed and established the set of recommendations based on these data.

The authors encourage a thorough determination of a patient’s cardiovascular health, which includes assessment of preexisting diseases and risks, prior to treatment with BTK inhibitors. The panel recommends ibrutinib not be used to treat patients with a history of ventricular arrhythmia. Patients found to have a high risk of cardiovascular adverse events are recommended to seek treatment with more selective BTK inhibitors other than ibrutinib such as acalabrutinib and zanubrutinib. Patients with prior heart failure should not be treated with BTK inhibitors at all. The investigators noted, however, that risks associated with newer drugs are unknown and need to be established. They also emphasized the advantage of multidisciplinary teams in managing any toxicities that emerge while maintaining a BTK inhibitor treatment regimen.

Although these recommendations establish baseline guidance for use of BTK inhibitors in patients with CLL, the authors indicated additional studies are necessary to optimize a treatment strategy.

Disclosure: For full disclosure of the study authors, visit ashpublications.org.


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