Managing BTK Inhibitor Toxicities

CE / CME

Optimizing the Use of BTK Inhibitors in B-Cell Malignancies: Addressing BTK Inhibitor Toxicities

Pharmacists: 1.00 contact hour (0.1 CEUs)

Physicians: Maximum of 1.00 AMA PRA Category 1 Credit

Nurses: 1.00 Nursing contact hour

Released: September 29, 2021

Expiration: September 28, 2022

Christopher R. Flowers
Christopher R. Flowers, MD, MS

Activity

Progress
1
Course Completed

In this module, Christopher R. Flowers, MD, MS, first reviews the biologic rationale and clinical role of Bruton tyrosine kinase (BTK) inhibitors in treating hematologic malignancies, including mantle cell lymphoma (MCL), chronic lymphocytic leukemia (CLL), Waldenström macroglobulinemia (WM), and marginal zone lymphoma (MZL). Then, Dr. Flowers discusses practical strategies for multidisciplinary management of BTK inhibitor–related adverse events (AEs) and identifies particular patient populations who may be at higher risk.

The key points discussed in this module are illustrated with thumbnails from the accompanying downloadable PowerPoint slidesets, which can be found here or downloaded by clicking any of the slide thumbnails in the module alongside the expert commentary.

Clinical Care Options plans to measure the educational impact of this activity. Several questions will be asked twice: once at the beginning of the activity and then once again after the discussion that informs the best choice. Your responses will be aggregated for analysis, and your specific responses will not be shared.

Before continuing with this educational activity, please take a moment to answer the following questions.

If you are a practicing healthcare professional, how many patients with hematologic B-cell malignancies do you provide care for in a typical month?

A 74-year-old man with hypertension, hypercholesterolemia, and mild renal insufficiency (creatinine 1.9 mg/dL; glomerular filtration rate GFR 50 mL/min) was diagnosed with CLL. His laboratory values are as follows: white blood cell (WBC) count 75,000/mm3; hemoglobin (Hb) 10 g/dL; del(17p) by FISH. The patient started on ibrutinib 420 mg QD. The pretreatment WBC of 75,000/mm3 rises to 200,000/mm3 but by 3 months has dropped to 37,000/mm3. His Hb initially drops to 9.3 g/dL but then normalizes, as does lactate dehydrogenase (LDH). At Month 3, the patient complains of moderate to severe joint stiffness and pain that has limited his ability to walk his dog, do any heavy lifting, or open jars or cans.

In your current practice, which of the following would you recommend for managing this patient’s grade 3 arthralgias?

Which of the following would you NOT counsel a patient to avoid when starting BTK inhibitor therapy?

In your current practice, how confident are you in safely initiating BTK inhibitor therapy in appropriate patients with B-cell malignancies including MCL, MZL, CLL/small lymphocytic lymphoma (SLL), and WM? Please rank your confidence on a 7-point scale where 1 is not confident and 7 is very confident.