For CLL patients with high-risk cytogenetics on ibrutinib who develop a cardiac event such as an MI, would you continue ibrutinib?

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)...

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.

Switchin...

Updated answer - 12/17/2024

Now, we have the results from BRUIN CLL-321 trial presented at ASH 2024, showing that in adult patients with CLL/SLL previously treated with a covalent BTK inhibitor, pirtobrutinib met its primary endpoint of progression-free survival and was superior to investigator's ch...

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 in...

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...