Cardiotoxicity of BTK inhibitors: ibrutinib and beyond. Issue 4 (3rd April 2022)

• Record Type: Journal Article
• Authors: Christensen, Bradley W.; Zaha, Vlad G; Awan, Farrukh T.
• Is Part Of: Expert review of hematology. Volume 15:Issue 4(2022)
• Page Start: 321
• Page End: 331
• Publication Date: 2022-04-03
• Subjects: Acalabrutinib -- atrial fibrillation -- cardio-oncology -- chronic lymphocytic leukemia -- hypertension -- ibrutinib -- non-Hodgkin lymphoma -- ventricular tachycardia -- zanubrutinib; Hematology -- Periodicals; 616.15005
• DOI: 10.1080/17474086.2022.2067526
• Languages: English
• ISSNs: 1747-4086

Abstract

ABSTRACT: Introduction: The development of Brutons Tyrosine Kinase (BTK) inhibitors has transformed the treatment of B-cell malignancies and other non-malignant conditions. Management of the unique cardiotoxic profile of these agents requires prompt recognition and a multi-disciplinary approach. Areas Covered: The increasing indications and addition of newer agents to clinical practice and emergence of BTK inhibitor-related cardiac adverse events have complicated the management decisions for utilization of this class of therapy. We review the incidence, mechanisms, and management approaches for BTK inhibitor-related atrial fibrillation, hypertension, and ventricular arrhythmias. Expert Opinion: The newer BTK inhibitor acalabrutinib represents a new standard of care in front-line chronic lymphocytic leukemia (CLL) given the results of the ELEVATE-RR trial demonstrating comparable efficacy and a more favorable toxicity profile especially with regard to cardiac adverse events as compared to ibrutinib. Often not recognized by clinicians, BTK inhibitor-induced hypertension is common and can be severe, requiring prompt recognition and initiation or adjustment of anti-hypertensive medications to prevent major adverse cardiac outcomes. Novel BTK inhibitors in development are being designed to overcome the patterns of resistance from first-generation agents and to minimize off-target kinase activity, with promising toxicity profiles in early trials.