Brukinsa Offers Better Response and Less Toxicity for CLL and SLL Treatment, But a Cure Is Still Needed


Two experts explain what patients need to know about the recent approval of Brukinsa for patients with chronic lymphocytic leukemia and small lymphocytic leukemia.

The Food and Drug Administration (FDA) recently approved Brukinsa (zanubrutinib) for patients with chronic lymphocytic leukemia (CLL) or small lymphocytic leukemia (SLL), offering this patient population a less toxic regimen than Ibrutinib (imbruvica), which is commonly used to treat these blood cancers.

“(Brukinsa) is a highly effective and safer alternative to (Imbruvica) so its availability is an important step forward for these patients,” Dr. Jennifer R. Brown, lead investigator on the ALPINE trial (one of the two studies that led to Brukinsa’s approval) and director of the CLL Center at the Dana-Farber Cancer Institute in Boston, said in an interview with CURE®. “Many of my patients on this drug say that they don’t even know they are on anything, yet their disease responds well.”

Brown explained that Brukinsa was not only more efficacious in fighting cancer than Ibrutinib, but it also came with fewer side effects, particularly cardiac (heart-related). Notably, this is likely because Brukinsa is more specified to find and attack its target on cancer cells.

READ MORE: Brukinsa May Cause Fewer Side Effects Than Other BTK Inhibitors for Patients with B-Cell Malignancies

“This is an option for CLL patients as a frontline or relapsed/refractory treatment that has better response rates and duration of response,” Dr. Lee Greenberger, chief scientific officer at the Leukemia & Lymphoma Society said in an interview with CURE®. “There is data to indicate the progression-free survival (time from treatment until disease worsens) is also better with (Brukinsa) versus (Imbruvica).”

However, like with all cancer treatments, Brukinsa was not completely without side effects.
The most common side effects that were observed in the trials that led to the approval were: decreased neutrophil count, upper respiratory tract infection, decreased platelet count, bleeding and musculoskeletal pain.

“I am willing to consider any patient for (Brukinsa). The patients in whom there would be more concern are those who require full-dose anticoagulation or who have significant underlying cardiac disease or who have had major bleeding events,” Brown said. “Patients should always discuss expected side effects and whether anything about their own situation makes those side effects more likely.”

While Brukinsa is an exciting advancement in the field, Brown and Greenberger said that there is still more work to do.

“Right now, we still give (Brukinsa) continuously, indefinitely. It would be great if we could get patients in remissions that do not require them to remain on therapy,” Brown said.

Greenberger echoed the need for a cure, as well as ongoing research looking at drug combinations for this patient population.

“BTK inhibitors given alone generate few complete responses. Relapses are expected,” he said. “Combination therapy of BTK inhibitors with (Venclexta [venetoclax]) and/or anti-CD20 antibodies show high rates of complete response and are likely to have longer remission rates. Cures for CLL patients (i.e. therapy no longer needed) [are] on the immediate horizon for some CLL patients with these drug combinations, or possibly with better CAR-T therapy.”

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