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Bruton Tyrosine Kinase Inhibitor Ibrutinib (PCI-32765) Has Significant Activity in Patients With Relapsed/Refractory B-Cell Malignancies
Open accessAbstract
Purpose: Survival and progression of mature B-cell malignancies depend on signals from the B-cell antigen receptor, and Bruton tyrosine kinase (BTK) is a critical signaling kinase in this pathway. We evaluated ibrutinib (PCI-32765), a small-molecule irreversible inhibitor of BTK, in patients with B-cell malignancies. Patients and Methods: Patients with relapsed or refractory B-cell lymphoma and chronic lymphocytic leukemia received escalating oral doses of ibrutinib. Two schedules were evaluated: one, 28 days on, 7 days off; and two, once-daily continuous dosing. Occupancy of BTK by ibrutinib in peripheral blood was monitored using a fluorescent affinity probe. Dose escalation proceeded until either the maximum-tolerated dose (MTD) was achieved or, in the absence of MTD, until three dose levels above full BTK occupancy by ibrutinib. Response was evaluated every two cycles. Results: Fifty-six patients with a variety of B-cell malignancies were treated over seven cohorts. Most adverse events were grade 1 and 2 in severity and self-limited. Dose-limiting events were not observed, even with prolonged dosing. Full occupancy of the BTK active site occurred at 2.5 mg/kg per day, and dose escalation continued to 12.5 mg/kg per day without reaching MTD. Pharmacokinetic data indicated rapid absorption and elimination, yet BTK occupancy was maintained for at least 24 hours, consistent with the irreversible mechanism. Objective response rate in 50 evaluable patients was 60%, including complete response of 16%. Median progression-free survival in all patients was 13.6 months. Conclusion: Ibrutinib, a novel BTK-targeting inhibitor, is well tolerated, with substantial activity across B-cell histologies.
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“The rapid clearance of ibrutinib (which has a half-life of 2–3 h) could also enable kinase selectivity; ibrutinib should maintain activity against BTK owing to prolonged covalent engagement, while the reversible inhibition of off-targets is minimized65.”
From Advances in covalent drug discovery (2022) · cites this paper as [65]
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Resistance to Bruton’s Tyrosine Kinase Signaling Pathway Targeted Therapies
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B-Cell Receptor Signaling Pathway: Mechanisms and Inhibitors
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Treatment of Chronic Lymphocytic Leukemia and Related Disorders
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Molekularbiologie maligner Lymphome
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Ibrutinib: a strong candidate for the future of mantle cell lymphoma treatment
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Π-π Stacked Polymeric Micelles as Carriers of Anticancer Therapeutics for Hematological Malignancies
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Mantle cell lymphoma: continuously improving the odds!
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“The target specificity, off-target activity and exact mechanism of action of these novel drugs, however, are not completely understood at this time [20–25].”
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Advances in the treatment of follicular lymphoma
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“Although currently approved in relapsed and refractory CLL [77] and mantle cell lymphoma, [78], it has demonstrated activity in a number of B-cell malignancies [79] including marginal zone lymphoma, Waldenstr€om’s macroglobulinemia, and the activated B-cell subtype of DLBCL [80].”
BackgroundAguiló, M. (2013) · RIUVic (UVic-UCC)
Metadata
- Authors
- Advani, R. H., Buggy, J. J., Sharman, J. P., Smith, S. M., Boyd, T. E., Grant, B., Kolibaba, K. S., Furman, R. R., Rodriguez, S., Chang, B. Y., Sukbuntherng, J., Izumi, R., Hamdy, A., Hedrick, E., & Fowler, N. H.
- Affiliations
- University of Vermont (US)
- Corresponding author
- Advani, Ranjana H.
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 2013-01-01
- Volume
- 31
- Issue
- 1
- Pages
- 88-94
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- PMC
- PMC5505166
- OpenAlex
- W2171771895
- Cited by
- 1,128
- References
- 32
- Citations by year
- 2026: 17 · 2025: 38 · 2024: 47 · 2023: 44 · 2022: 46 · 2021: 90 · 2020: 79 · 2019: 92 · 2018: 73 · 2017: 117 · 2016: 94 · 2015: 135 · 2014: 134 · 2013: 110
- FWCI
- 58.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Oncology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Abbott Laboratories
- GlaxoSmithKline
- Gilead Sciences
- Celgene
- Genentech
- Takeda Oncology
- Pharmacyclics
- National Cancer Institute (P30CA016672)
- Topics
- Health Sciences › Medicine › Hematology › Chronic Lymphocytic Leukemia Research
- Health Sciences › Medicine › Pathology and Forensic Medicine › Lymphoma Diagnosis and Treatment
- Health Sciences › Medicine › Dermatology › Cutaneous lymphoproliferative disorders research
- Keywords
- ibrutinib, BTK inhibitors, relapsed/refractory B-cell malignancies, B-cell lymphoma, chronic lymphocytic leukemia, B cell receptor signaling, irreversible kinase inhibitors, BTK occupancy, dose-limiting toxicity, pharmacokinetics, progression-free survival
- MeSH terms
- Agammaglobulinaemia Tyrosine Kinase, Adenine, Administration, Oral, Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasm Recurrence, Local, Neoplasm Staging, Piperidines, Prognosis, Protein-Tyrosine Kinases, Pyrazoles, Pyrimidines, Leukemia, Lymphocytic, Chronic, B-Cell, Lymphoma, B-Cell, Salvage Therapy, Drug Resistance, Neoplasm, Maximum Tolerated Dose, Protein Kinase Inhibitors
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