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2015 ; 11
(ä): 979-90
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A critical appraisal of ibrutinib in the treatment of mantle cell lymphoma and
chronic lymphocytic leukemia
#MMPMID26150724
Tucker DL
; Rule SA
Ther Clin Risk Manag
2015[]; 11
(ä): 979-90
PMID26150724
show ga
Although chemo-immunotherapy remains at the forefront of first-line treatment for
mantle cell lymphoma (MCL) and chronic lymphocytic leukemia (CLL), small
molecules, such as ibrutinib, are beginning to play a significant role,
particularly in patients with multiply relapsed or chemotherapy-refractory
disease and where toxicity is an overriding concern. Ibrutinib is a
first-in-class, oral inhibitor of Bruton's tyrosine kinase, which functions by
irreversible inhibition of the downstream signaling pathway of the B-cell
receptor, which normally promotes cell survival and proliferation. Early clinical
trials have demonstrated excellent tolerability and a modest side-effect profile
even in elderly and multiply pretreated patient cohorts. Although the majority of
disease responses tend to be partial, efficacy data have also been encouraging
with more than two-thirds of patients with CLL and MCL demonstrating a durable
response, even in the high-risk disease setting. Resistance mechanisms are only
partially understood and appear to be multifactorial, including the binding site
mutation C481S, and escape through other common cell-signaling pathways. This
article appraises the currently available data on safety and efficacy from
clinical trials of ibrutinib in the management of MCL and CLL, both as a single
agent and in combination with other therapies, and considers how this drug is
likely to be used in future clinical practice.