How We Manage Patients with Indolent B-Cell Malignancies on Bruton's Tyrosine Kinase Inhibitors: Practical Considerations for Nurses and Pharmacists

by Selleckchem | Jul 19 2023

The most common forms of B-cell malignancy, non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia (CLL), have seen a drastic shift in the treatment landscape over the last two decades with the introduction of targeted agents. Among them are Bruton's tyrosine kinase (BTK) inhibitors, which have demonstrated excellent efficacy in indolent B-cell NHLs and CLL. Although BTK inhibitors are generally thought to be more tolerable than chemoimmunotherapy, they are associated with a unique safety profile including varying rates of rash, diarrhea, musculoskeletal events, cardiovascular events, and bleeding. Ibrutinib was the first BTK inhibitor to gain a Health Canada indication, followed by second-generation BTK inhibitors acalabrutinib and zanubrutinib, which have better safety profiles compared to ibrutinib, likely due to their improved selectivity for BTK. As BTK inhibitors are oral agents given continuously until disease progression, long-term adverse event (AE) monitoring and management as well as polypharmacy considerations are important for maintaining patient quality of life. This paper intends to serve as a reference for Canadian nurses and pharmacists on dosing, co-administration, and AE management strategies when caring for patients with indolent B-cell NHL or CLL being treated with BTK inhibitors.

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Title: Dosing, Co-administration, and Adverse Event Management Strategies for BTK Inhibitors in Indolent B-cell NHL and CLL: A Reference for Canadian Nurses and Pharmacists

Abstract: The treatment landscape for non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia (CLL) has significantly evolved in recent years with the introduction of targeted agents, including Bruton's tyrosine kinase (BTK) inhibitors. These inhibitors have demonstrated remarkable efficacy in indolent B-cell NHLs and CLL. While BTK inhibitors are generally considered more tolerable than traditional chemoimmunotherapy, they are associated with a distinct safety profile that includes potential adverse events (AEs) such as rash, diarrhea, musculoskeletal events, cardiovascular events, and bleeding. This paper aims to provide Canadian nurses and pharmacists with a comprehensive reference guide on dosing, co-administration, and AE management strategies when caring for patients with indolent B-cell NHL or CLL undergoing treatment with BTK inhibitors.

1. Introduction
   - Background on indolent B-cell NHL and CLL
   - Evolution of treatment landscape with the introduction of targeted agents
   - Role of BTK inhibitors in the management of indolent B-cell NHL and CLL

2. Overview of BTK Inhibitors
   - Brief description of Bruton's tyrosine kinase and its role in B-cell malignancies
   - Mechanism of action of BTK inhibitors
   - Comparison of first-generation (ibrutinib) and second-generation (acalabrutinib, zanubrutinib) BTK inhibitors

3. Dosing and Administration Considerations
   - Recommended dosing regimens for different BTK inhibitors
   - Administration instructions and guidance for optimal drug absorption
   - Strategies for dose modifications and interruptions

4. Co-administration and Drug Interactions
   - Potential drug interactions with BTK inhibitors
   - Common medications and substances to avoid or use with caution
   - Guidance on dose adjustments when co-administering interacting agents

5. Adverse Event Management Strategies
   - Overview of common AEs associated with BTK inhibitors
   - Patient education and monitoring for early detection of AEs
   - Evidence-based management approaches for specific AEs
     - Rash and skin toxicity
     - Diarrhea
     - Musculoskeletal events
     - Cardiovascular events
     - Bleeding

6. Polypharmacy Considerations
   - Recognition of potential drug-drug interactions with concomitant medications
   - Strategies for minimizing polypharmacy and optimizing medication regimens
   - Collaborative care coordination among healthcare providers

7. Patient Education and Quality of Life
   - Importance of patient counseling and education on potential AEs
   - Strategies for managing treatment-related AEs to improve quality of life
   - Supportive care measures and resources for patients

8. Conclusion
- Summary of key considerations for dosing, co-administration, and AE management
- Importance of multidisciplinary collaboration in optimizing patient outcomes

This paper aims to serve as a valuable resource for Canadian nurses and pharmacists involved in the care of patients with indolent B-cell NHL or CLL receiving BTK inhibitors. By understanding the dosing, co-administration, and AE management strategies, healthcare professionals can play a crucial role in enhancing patient adherence, optimizing treatment outcomes, and maintaining patient quality of life during long-term BTK inhibitor therapy.