Would you ever consider using ibrutinib in CLL patients who have received first line acalabrutinib and then progressed?
Answer from: Medical Oncologist at Academic Institution
There is no benefit of switching between covalent BTKi (Acalabrutinib, zanubrutinib, or ibrutinib) especially in CLL which, in most cases, is driven by a C481S which renders all three ineffective. The only rationale situation to switch between the three would be intolerance. In this situation, switc...
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Answer from: Medical Oncologist at Community Practice
Almost never - there have been rare exceptions (patient with no other options, not eligible for a clinical trial) - but based on resistance mechanisms and corroborated by real-world studies, we know that repeating a covalent BTKi in the setting of progression on a covalent BTKi gives only a temporar...
Answer from: Medical Oncologist at Academic Institution
No. Ibrutinib binds to the same pocket in BTK as acalabrutinib and resistance mechanisms are similar. For such patients, I would consider venetoclax-based therapy or non covalent BTK inhibitors such as pirtobrutinib.