Optimizing Treatment of CLL With BTK Inhibitors in Canada. Applying Evidence & Experience – Dr. Christine Chen (11/1/23)-Webinar Case

Optimizing Treatment of CLL With BTK Inhibitors in Canada. Applying Evidence & Experience – Dr. Christine Chen (11/1/23)-Webinar Case

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Q1: Can cardiotoxicity with BTK inhibitors be predicted?
a. Yes to some extent, as underlying cardiac risks such as hypertension appear to precede the onset of cardiac arrhythmias. However, not all patients with hypertension develop cardiotoxicity and likewise, not all cardiotoxicities occur in patients with known hypertension. However, cardiotoxicity is still uncommon and there is no biomarker or risk
factor that can predict cardiotoxicity with certainty.
b. Yes, those with underlying hypertension are at high risk of cardiotoxicity.
c. No, there are no known predictive factors or risks for cardiotoxicity.

Q2: Do patients requiring BTK inhibitor dose reduction have shorter survival outcomes?
a.: No and in fact BTK inhibitor dose reductions may allow patients to stay on treatment longer and can be associated with prolonged PFS outcomes.
b. Yes, there is a clear dose-efficacy correlation.
c. Yes, it is therefore important to aim for full dose BTK inhibitor at all times.

Q3  If a patient progresses on ibrutinib, can a switch to an alternate BTK inhibitor be effective?

a. The mechanism of resistence on covalent-binding BTK inhibitors such as ibrutinib, acalabrutinib or zanubrutinib are similar and therefore switching from one to the other after progression will not be effective. However, noncovalentbinding BTK inhibitors such as pirtobrutinib can be effective.
b. Yes, as the BTK mutations that cause resistence vary between ibrutinib, acalabrutinib, and zanubrutinib.
c. No, BTK inhibitor progression should be treated with a class switch, such as venetoclax.

Speaker: Christine Chen, MD MEd FRCPC
Princess Margaret Cancer Centre
Associate Professor
Division of Medical Oncology and
Hematology Department of Medicine
Temerty Faculty of Medicine
University of Toronto

Learning Objectives:
1. Review the differences and rationale for use of available BTK inhibitors in Canada.

2. Discuss the impact of dose modifications, interruptions and early cessation of BTK inhibitors.

3 Identify how to minimize and manage BTK toxicity.

Accreditation: This activity is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada and approved by the Canadian Association of Pathologists (CAP-AC). You may claim a maximum of 1.0 hours. Certificates of Attendance will be sent to all CHS members who participate.

This webinar is supported by a grant from BEIGENE and the CHS Scientific Planning Committee has planned it to achieve scientific integrity, objectivity and balance.

Scientific Planning Committee

Dr. Pallavi Ganguli – Resident Physician, Hematology
Danyal Ladha – Resident Physician, Hematology
Dr. Joanne Britto – Clinical Fellow, Malignant Hematology (Lymphoproliferative Disorders)
Dr. Yan Xu – Fellow Physician, Hematology/Thrombosis
Dr. Siraj Mithoowani – Clinical Hematologist at St. Joseph’s Healthcare, Hamilton
Dr. Hassan Sibai – Assistant Professor of Medicine, Faculty of Medicine, University of Toronto and Staff Physician,
Division of Medical Hematology & Oncology, Princess Margaret Cancer Centre

Conflict of Interest: None