How has ibrutinib changed how we manage multiple myeloma?
Ibrutinib has shown great efficacy at inducing deep and durable IgM responses, as well as improving hematologic parameters in patients with WM. As such, ibrutinib has changed how we manage patients with WM, although we all have to be mindful of its particular toxicity profile.
When was ibrutinib approved for the treatment of multiple sclerosis (MS)?
In January 2015, the oral Bruton’s tyrosine kinase (BTK) inhibitor ibrutinib (Imbruvica®, Pharmacyclics Inc, Sunnyvale, CA, USA) was approved by the United States (US) Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for its use in patients with symptomatic WM.
Is ibrutinib an effective treatment for Wolff-Parkinson-White (WPW) syndrome?
Although the studies available were performed in WM patients with relapsed or refractory WM patients, the approval by the FDA supports the use of ibrutinib in previously-untreated symptomatic WM patients.
What is the efficacy of ibrutinib in the treatment of MyD88?
Overall responses are seen in 91% of MYD88-only mutated patients within 3 cycles of ibrutinib but in 76% of MYD88 and CXCR4-mutated patients by cycle 9. Major responses are expected in 74% of MYD88-only mutated patients within the first 3 cycles of therapy, but in 52% MYD88 and CXCR4-mutated patients within 9 months of therapy [Treon et al.2015a].
How long does it take for ibrutinib to start working?
Official Answer. In some people, very good partial clinical responses to Imbruvica may occur within three to six months. Imbruvica is usually given until disease progression or unacceptable toxicity occurs, or in the case of graft vs host disease, recurrence of an underlying malignancy.
Can ibrutinib cure Waldenstrom's?
Ibrutinib Improves Long-Term Outcomes in Waldenstrom's Macroglobulinemia. Adding ibrutinib to rituximab improves long-term outcomes in patients with Waldenstrom's macroglobulinemia (WM), according to final results from the phase 3 iNNOVATE trial.
When should I hold ibrutinib?
Ibrutinib should be held 3-7 days prior to and after any invasive procedures owing to the risk of periprocedural bleeding. Therefore, if a patient needs a surgical procedure, I attempt to get it done before initiating ibrutinib.
When do you treat Waldenstrom macroglobulinemia?
Watchful waiting. Some people with Waldenstrom macroglobulinemia may not need immediate treatment if they are otherwise healthy and the disease is not causing any symptoms or problems. In these situations, patients are closely monitored, and active treatment begins if symptoms develop or the IgM level increases.
What is new in the treatment of Waldenstrom macroglobulinemia?
Bortezomib, dexamethasone, and rituximab recently have been shown to be an active combination to treat Waldenstrom macroglobulinemia.
How do you treat relapsed Waldenstrom?
The treatment of WM has evolved rapidly, with treatment options that include anti-CD20 monoclonal antibody-based combinations and BTK inhibitors. The choice of therapy is based on the need for rapid disease control, presence of specific disease complications, and patient's age.
What is ibrutinib toxicity?
Ibrutinib is generally well tolerated drug with rapid and durable responses but has some side events. The most common side effects are diarrhea, upper respiratory tract infection, bleeding, fatigue and cardiac side effects. These events are generally mild (grade I-II).
What happens when you stop taking ibrutinib?
Overall, the temporary disruption ranged from one to 59 days, and the number of interruptions, from one to seven. The most common reasons were periprocedural (treatment stopped around the same time as a medical procedure such as a biopsy), bleeding, neutropenia, and joint and muscle pain.
What is the half life of ibrutinib?
The half-life of ibrutinib is 4 to 6 hours. radioactivity was excreted within 168 hours, with the majority (80%) excreted in the feces and less than 10% accounted for in urine.
Can Waldenstrom macroglobulinemia go into remission?
Can Waldenstrom macroglobulinemia go into remission? There's a small chance that WM can go into remission, but it's not typical. Doctors have only seen complete remission of the disease in a few people. Current treatments do not prevent relapse.
What are the end stages of Waldenstrom's?
Staging/Prognostic Scoring System for Waldenstrom Macroglobulinemia/Lymphoplasmacytic LymphomaScoreStage3-year WM-related mortality1Low10%2Intermediate14%3High38%4-5Very high48%1 more row•Dec 21, 2020
How long does it take for rituximab to respond to Waldenstrom's?
Results: Twelve patients (44%; 95% confidence interval, 25.5% to 64.7%) achieved a partial response after treatment with rituximab. Median time to response was 3.3 months (range, 2.2 to 7.1 months).