BTK Inhibitors Offer CLL Patients Long-Lasting Disease Control
- BTK inhibitors are targeted therapies that have transformed the treatment of chronic lymphocytic leukemia (CLL), providing long-lasting disease control for many patients.
- Initially used for CLL that had returned after earlier treatment, BTK inhibitors are now a standard first-line option for many newly diagnosed patients, says Dr. Talal Hilal, a Phoenix-based hematologist at Mayo Clinic Arizona.
- Unlike chemotherapy, BTK inhibitors target a specific pathway CLL cells need to survive, helping stop cancer growth while generally causing fewer side effects.
- Although resistance can develop over time, newer non-covalent BTK inhibitors offer another effective treatment option, allowing many patients to continue controlling their disease.
“BTK inhibitors have been on the market for a little over 10 years now,” Dr. Talal Hilal, a Phoenix-based hematologist at Mayo Clinic Arizona, tells SurvivorNet. These therapies “started coming onto the scene as a treatment approach for relapse/refractory disease,” which is when a CLL patient relapses out of remission and stops responding to treatment.
Read MoreBTK Inhibitors: ‘Excellent Disease Control’
BTK inhibitors are a type of targeted therapy, meaning they will target cancer specifically rather than attacking the rest of the body and hoping to kill the cancer in the process, which is what chemotherapy does. Dr. Hilal explains that BTK inhibitors can be used alone. “As a class, they target the B-cell receptor, which is on the surface of the CLL cells, and that stops them from growing and actually kills them and decreases the amount of CLL cells in the body.”“They most often do not eradicate all the disease,” he adds, “but they really provide excellent disease control for many years.”
The exact length of response varies from person to person.
When CLL Progresses: What’s Next?
It is important to know that CLL is not curable, but with these advances, it is highly manageable, and for some patients, they may not even need treatment initially, or at all.
For patients on BTK inhibitors, this disease control can last for years. Eventually, however, the leukemia may become resistant to treatment.
BTK inhibitors have dramatically improved outcomes for many patients, but at some point — usually many years later — their disease may eventually progress.
Expert Resources for CLL Patients
- CLL Treatment Decision Making — Exploring All Your Options To Find What’s Right For You
- CLL Treatment: The Side Effects to Expect & Why Reporting All New Symptoms is Crucial
- Active Surveillance For Chronic Lymphocytic Leukemia (CLL)
- BTK Inhibitors: Finding The Right Fit For Chronic Lymphocytic Leukemia (CLL) Patients
- ‘The Eye of the Tiger’ — Why Mindset and Lifestyle are So Important During Treatment for CLL
“Over time, if you start something like a BTK inhibitor, patients who are on it for years and years typically will experience progression at some point, and that’s usually driven by resistance to the medicine.”
Dr. Hilal explains that the “B-cell receptor develops methods of not responding to the therapy anymore, and so the cells are able to grow again, and so you start seeing increase in the lymph node size, a rise in the white blood cell count, and that’s usually when you start thinking about moving on to the next line of treatment.”
Covalent vs. Non-Covalent BTK Inhibitors
BTK inhibitors fall into two main categories based on how they attach to the BTK protein. Covalent BTK inhibitors — including ibrutinib (Imbruvica), acalabrutinib (Calquence), and zanubrutinib (Brukinsa) — bind permanently to the protein, while non-covalent BTK inhibitors, such as pirtobrutinib (Jaypirca), attach in a reversible way.
“The covalent BTK inhibitors are often used in the first-line treatment setting,” says Dr. Hilal. “When you do have resistance develop over time, non-covalent BTK inhibitors remain a viable option for most patients.”
“And so we still focus on the same target,” he notes. “We just use a different therapy that has different mechanisms of overcoming the resistance, and that gives us, again, disease control for a few more years.”
“It’s a very important treatment approach,” he stresses. “We use other mechanisms of targeting CLL in addition to BTK inhibition, and a lot of times the combinations tend to work very well.”
Today, doctors have multiple targeted therapies available, allowing many patients to move from one effective treatment to another if their disease eventually becomes resistant.
Questions To Ask Your Doctor
- Which BTK inhibitor do you recommend in my case?
- Should I consider a combination therapy?
- What potential side effects should I be monitoring for at home?
- What are my options if my CLL continues to progress?
Learn more about SurvivorNet's rigorous medical review process.
