ZANUBRUTINIB FOR PATIENTS WITH RELAPSED OR REFRACTORY CHRONIC LYMPHOCYTIC LEUKEMIA

The Safety of Bruton's Tyrosine Kinase Inhibitors in B-cell Malignancies: A Systematic Review

B-cell malignancies, most notably lymphomas, make up most of the non-Hodgkin lymphomas in the United States. There is limited randomized data comparing 1^st and 2^nd generation Bruton Tyrosine Kinase inhibitors. Our aim was to compare the safety profiles of 1^st versus 2^nd generation Bruton Tyrosine Kinase inhibitors. A systematic search was performed from database inception to January 13, 2020. Studies with Bruton Tyrosine Kinase inhibitor monotherapy for the treatment of B-cell malignancies in the adult population (> 18 years old) were utilized and the adverse events were extracted. Fifty-five studies that met the inclusion criteria were included in the systematic review with forty-one studies with 1^st generation and fourteen studies with 2^nd generation. The review included both clinical trials and retrospective studies with average time of follow-up of 2 years for the 1^st generation group and 18 months for the 2^nd generation group. We found that the incidence of cardiovascular adverse events was significantly higher in the 1^st generation group (20.8%) as compared to the 2^nd generation group (6.3%). However, there was a higher incidence of hematologic/oncologic and gastrointestinal side effects in the 2^nd generation group compared to the 1^st (62.3% compared to 39.2% and 36.9% compare to 28.9%). The number of Grade 5 cardiovascular events (death) were same in the 1^st generation group compared to the 2^nd generation. Further research is needed to develop highly selective Bruton Tyrosine Kinase inhibitors to avoid unwanted adverse events by minimizing off-targets. This article is protected by copyright. All rights reserved.

Inhibitors targeting Bruton's tyrosine kinase in cancers: drug development advances

Bruton’s tyrosine kinase (BTK) inhibitor is a promising novel agent that has potential efficiency in B-cell malignancies. It took approximately 20 years from target discovery to new drug approval. The first-in-class drug ibrutinib creates possibilities for an era of chemotherapy-free management of B-cell malignancies, and it is so popular that gross sales have rapidly grown to more than 230 billion dollars in just 6 years, with annual sales exceeding 80 billion dollars; it also became one of the five top-selling medicines in the world. Numerous clinical trials of BTK inhibitors in cancers were initiated in the last decade, and ~73 trials were intensively announced or updated with extended follow-up data in the most recent 3 years. In this review, we summarized the significant milestones in the preclinical discovery and clinical development of BTK inhibitors to better understand the clinical and commercial potential as well as the directions being taken. Furthermore, it also contributes impactful lessons regarding the discovery and development of other novel therapies.