Oncologist Discusses Shifting Treatment Paradigm in Chronic Lymphocytic Leukemia

Farrukh Awan, MD, professor of internal medicine, UT Southwestern Medical Center, offers insight into how a new second-generation BTK inhibitor might impact the treatment paradigm in chronic lymphocytic leukemia.

This podcast is a highlight from part 2 of a roundtable discussion focused on chronic lymphocytic leukemia, titled, "Payer, Clinical Considerations for Treating Patients With Zanubrutinib."

The first part of the roundtable can be viewed here.

Read the transcript:

I think zanubrutinib is very nicely poised to become the front runner in terms of the preferred BTK inhibitor, at least for the time being. We know it's fairly well-tolerated, and it appears to be better tolerated than ibrutinib. Obviously, we already have approval for acalabrutinib, which also is a fairly well-tolerated agent.

Zanubrutinib has its own unique issues with cytopenias, primarily neutropenia, which requires some management, but I feel that zanubrutinib potentially will be the front runner especially in the CLL space.

Interestingly, for zanubrutinib, the follow-up is relatively short for the ALPINE study, but it does appear that the difference, at least at the early time point, is roughly 10%. Will the curves get caught up later on in the follow-up? We don't know.

But I think the point here, again, is most of the problems that happen with ibrutinib that result in discontinuations happen early on in the treatment course. Once patients go through the first 6 to 12 months, they tend to do well.

Will that be the factor that results in zanubrutinib being the better agent in the long run, or whether this will be a sheer efficacy on target effect? I don't think we'll be able to answer that question for sure. Hopefully the longer follow-up will be able to piece it apart.

But this is exactly where the toxicity, quality of life, and cost related to managing toxicity are the kinds of things that we need to focus on. If you have a drug that is better tolerated and results in lesser admissions, discontinuation, interruptions, lab testing, more follow-up, more frequent follow-up with the primary providers, then I think it's a win-win situation. We'll always go with the drug that is better tolerated if the efficacy is similar, which in zanubrutinib’s case, appears to be better, as least as compared to ibrutinib.

I feel that zanubrutinib has the chance to be the preferred drug for CLL, as well as other low-grade lymphoid malignancies, once it starts getting approval in those indications.