For CLL patients with high-risk cytogenetics on ibrutinib who develop a cardiac event such as an MI, would you continue ibrutinib?
Would you continue ibrutinib even if they are placed on anti-platelet therapy such as clopidogrel or ticagrelor?
When do you switch to an alternate BTKi?
Answer from: Medical Oncologist at Community Practice
It depends on the cardiac event (and the CLL status). After any serious event, if the CLL is under good control (clinical CR), I think it is very acceptable to stop the ibrutinib and wait until clinical progression occurs - which can be a while for some patients (median 2 years from the E1912 study)...
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Answer from: Medical Oncologist at Academic Institution
The evidence for ibrutinib toxicity is best illustrated in patients with uncontrolled hypertension. Patients with a history of controlled atrial fibrillation have been shown to be able to take ibrutinib safely. Ibrutinib does inhibit platelets and therefore patients on antiplatelet therapy are at ...
Answer from: Medical Oncologist at Academic Institution
I would stop ibrutinib in such a situation. I worry about cardiac adverse events with ibrutinib. Though rare, ventricular tachycardia and sudden cardiac deaths have been described in patients taking ibrutinib and the risk is higher if patients had a prior h/o heart disease or hypertension. &nbs...
Comments
Medical Oncologist at Columbia University Medical Center
As noted, it does depend on the nature of the seri...
As noted, it does depend on the nature of the seri...
Medical Oncologist at NYU Winthrop Hospital
Agree with this approach.
Agree with this approach.
Answer from: Medical Oncologist at Community Practice
Ibrutinib is associated with a nearly two-fold increase in the risk of atrial fibrillation (AF), bleeding, and heart failure but it is not associated with a higher risk of stroke or myocardial infarction. The 3-year incidence of AF-related healthcare contact was 22.7% in ibrutinib-treated patients a...
Answer from: at Academic Institution
Ibrutinib carries cardiotoxic risk as mentioned above, afib, HTN, CHF, hypercoagulable effects which may lead to acute MI or CVA and ventricular arrhythmias (summarized in Salem et al., PMID 31558250.). Acute MI is rarely but not never reported. And given other cardiac toxicities may occur in patien...