BTK Inhibitors for CLL Patients: What Are the Risks?

Newer drugs have fewer side effects

• The first-generation BTK inhibitor ibrutinib (brand name: Imbruvica) can cause chronic side effects such as arthralgias, atrial fibrillation, and bruising
• Second-generation therapies are better tolerated
• Headache is a common side effect with acalabrutinib (brand name: Calquence), but it is manageable

Bruton’s tyrosine kinase (BTK) inhibitors have provided us with a more targeted way to treat leukemia and lymphoma patients. But, as with any other therapeutic option, they do have side effects. In general, second-generation BTK inhibitors such as zanubrutinib (brand name: Brukinsa) and acalabrutinib (brand name: Calquence) tend to have fewer adverse effects than the first-generation therapy, ibrutinib (brand name: Imbruvica).

“Ibrutinib tends to have a lot of chronic side effects: arthralgias, atrial fibrillation, bruising, bleeding, and fatigue,” Dr. James Gerson, hematologist-oncologist at Penn Medicine, tells SurvivorNet Connect.

The one unique side effect with acalabrutinib is headache. “But it does seem to be very caffeine responsive, and thus is very manageable for the majority of patients,” Dr. Gerson adds. “I find that patients who have a cup of coffee in the morning really don’t have much in the way of headache.”