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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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Simple determination of plasma ibrutinib concentration using high‐performance liquid chromatography
Yasu, T., Momo, K., Yasui, H., & Kuroda, S. (2018) · Biomedical Chromatography · doi:10.1002/bmc.4435 · Cited by 35
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Till, K. J., Pettitt, A. R., & Slupsky, J. R. (2015) · The Journal of Immunology · doi:10.4049/jimmunol.1402304 · Cited by 34
“These include idelalisib (CAL-101; GS-1101), ibrutinib (PCI-32765), and fostamatinib (R406), which inhibit, respectively, PI3Kd (20), Bruton’s tyrosine kinase (BTK) (21), and spleen tyrosine kinase (SYK), although fostamatinib has additional activity against some other kinases (22, 23).”
BackgroundMantle cell lymphoma: state of the art.
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Qiu, Q., Lu, M., Li, C., Luo, X., Liu, X., Hu, L., Liu, M., Zheng, H., Zhang, H., Liu, M., et al. (2018) · AAPS PharmSciTech · doi:10.1208/s12249-018-1147-4 · Cited by 34
Hampel, P. J., Call, T. G., Rabe, K. G., Ding, W., Muchtar, E., Kenderian, S. S., Wang, Y., Leis, J. F., Witzig, T. E., Koehler, A. B., et al. (2020) · The Oncologist · doi:10.1634/theoncologist.2020-0388 · Cited by 35
“Transient lymph node enlargement, often coinciding with drops in ALC, had been observed even later in the course of patients responding well to ibrutinib in an intermittent dosing protocol [26].”
BackgroundVascular Impact of Cancer Therapies: The Case of BTK (Bruton Tyrosine Kinase) Inhibitors
Fleming, M. R., Xiao, L., Jackson, K. D., Beckman, J. A., Barac, A., & Moslehi, J. J. (2021) · Circulation Research · doi:10.1161/circresaha.121.318259 · Cited by 36
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“An estimated 19,970 Americans died of Non-Hodgkin Lymphoma in 2015(1), despite the availability of modern immunochemotherapy regimens and the introduction of novel agents such as ibrutinib and idelalisib.(2,3) This statistic emphasizes the need for additional improvements in the therapeutic armamentarium for lymphomas.”
BackgroundBohers, É., Mareschal, S., Bertrand, P., Viailly, P., Dubois, S., Maingonnat, C., Ruminy, P., Tilly, H., & Jardin, F. (2014) · Leukemia & lymphoma/Leukemia and lymphoma · doi:10.3109/10428194.2014.941836 · Cited by 36
Novel Therapeutic Approaches to Allosensitization and Antibody-mediated Rejection
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Wang, S., Mondal, S., Zhao, C., Berishaj, M., Ghanakota, P., Batlevi, C. L., Doǧan, A., Seshan, V., Abel, R., Green, M. R., et al. (2019) · JCI Insight · doi:10.1172/jci.insight.127566 · Cited by 33
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“Hence, novel therapeutic approaches targeting diverse oncogenic signaling pathways in DLBCL are under investigation, including spleen tyrosine kinase inhibitors [3], Bruton’s tyrosine kinase inhibitor [4], protein kinase C β inhibitor [5], histone deacetylase inhibitor [6], mammalian target of rapamycin (mTOR) inhibit…”
BackgroundCrochiere, M., Baloglu, E., Klebanov, B., Donovan, S., del Alamo, D., Lee, M. S., Kauffman, M., Shacham, S., & Landesman, Y. (2015) · OncoTarget · doi:10.18632/oncotarget.6495 · Cited by 40
“Similar occupancy assays have been developed for other drug-target interactions such as ibrutinib/Bruton tyrosine kinase [35, 36] and MDX-1106/programmed death-1 [37] proteins.”
Bruton tyrosine kinase inhibition in chronic lymphocytic leukemia
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Bruton’s tyrosine kinase inhibitors in B-cell lymphoma: current experience and future perspectives
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Recent survival trends in diffuse large B‐cell lymphoma––Have we made any progress beyond rituximab?
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Idelalisib for the treatment of non-Hodgkin lymphoma
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“Ibrutinib has shown some activity in other subtypes of iB-NHL,[19] where its investigation is ongoing.”
Backgroundde Rooij, M. F. M., Kuil, A., Kraan, W., Kersten, M. J., Treon, S. P., Pals, S. T., & Spaargaren, M. (2015) · Haematologica · doi:10.3324/haematol.2015.137265 · Cited by 32
“In these patients, the BCR signalosome inhibitors ibrutinib and idelalisib induce a rapid decrease in lymphadenopathy, accompanied by transient lymphocytosis.(6,9-11) In CLL and MCL, we have previously demonstrated that ibrutinib and idelalisib target BCR-controlled - and ibrutinib also chemokinecontrolled - integrin-…”
BackgroundTobinai, K., Ogura, M., Ishizawa, K., Suzuki, T., Munakata, W., Uchida, T., Aoki, T., Morishita, T., Ushijima, Y., & Takahara, S. (2015) · International Journal of Hematology · doi:10.1007/s12185-015-1900-3 · Cited by 33
“However, patients receiving lower doses start losing full occupancy at 24 h, which is consistent with a previous report [14].”
BackgroundMethodResultInfluentialIbrutinib in Waldenström macroglobulinemia: latest evidence and clinical experience
Castillo, J. J., Palomba, M. L., Advani, R. H., & Treon, S. P. (2016) · Therapeutic Advances in Hematology · doi:10.1177/2040620716654102 · Cited by 32
“The mean half-life is 2–3 hours, and there is no accumulation of ibrutinib after repeated daily dosing [Advani et al. 2013].”
BackgroundResultSelf-citationB-cell receptor signaling in chronic lymphocytic leukemia and other B-cell malignancies.
Koehrer, S., & Burger, J. A. (2016) · PubMed · Cited by 31
Treatment of splenic marginal zone lymphoma
Kalpadakis, C. H., Pangalis, G. A., Angelopoulou, M. K., & Vassilakopoulos, T. P. (2016) · Best Practice & Research Clinical Haematology · doi:10.1016/j.beha.2016.07.004 · Cited by 31
Rood, J. J. M., Dormans, P. J. A., van Haren, M. J., Schellens, J. H. M., Beijnen, J. H., & Sparidans, R. W. (2018) · Journal of Chromatography B · doi:10.1016/j.jchromb.2018.05.011 · Cited by 31
“It is a first in class BTK inhibitor which inactivates the NFκB pathway, and is registered for mantle cell lymphoma, chronic lymphocytic leukemia, Waldenström's macroglobulinemia [3], marginal zone lymphoma, and chronic graft versus host disease [4].”
BackgroundChronic Lymphocytic Leukaemia in 2020: the Future Has Arrived
Milne, K. M., Sturrock, B. R., & Chevassut, T. J. T. (2020) · Current Oncology Reports · doi:10.1007/s11912-020-0893-0 · Cited by 33
Rationale for once-daily or twice-daily dosing of zanubrutinib in patients with mantle cell lymphoma
Ou, Y. C., Tang, Z., Novotny, W. F., Cohen, A. C., Wang, K., Liu, L., Gao, Y., & Sahasranaman, S. (2021) · Leukemia & lymphoma/Leukemia and lymphoma · doi:10.1080/10428194.2021.1929961 · Cited by 31
“Furthermore, Ctrough/IC50 (unbound) ratios for zanubrutinib following the QD dose are considerably higher than those of ibrutinib and acalabrutinib where compelling clinical efficacy data has been reported in patients with multiple B-cell malignancies [21,22].”
BackgroundBruton's tyrosine kinase inhibition for the treatment of allergic disorders
Lin, E. V., Suresh, R. V., & Dispenza, M. C. (2024) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2024.03.002 · Cited by 30
“Ex vivo basophil activation has even been used as a surrogate marker for in vivo drug occupancy of BTK in peripheral blood mononuclear cells, including in ibrutinib’s phase 1 clinical trial 15 .”
Accelerated therapeutic progress in diffuse large B cell lymphoma
Cai, Q., Westin, J. R., Fu, K., Desai, M., Zhang, L., Huang, H., Jiang, W., Liang, R., Qian, Z., Champlin, R. E., et al. (2013) · Annals of Hematology · doi:10.1007/s00277-013-1979-7 · Cited by 30
Ibrutinib in chronic lymphocytic leukemia and B cell malignancies
Brown, J. R. (2013) · Leukemia & lymphoma/Leukemia and lymphoma · doi:10.3109/10428194.2013.803226 · Cited by 30
Albitar, A., Ma, W., DeDios, I., Estella, J. J., Ahn, I. E., Farooqui, M. Z. H., Wiestner, A. U., & Albitar, M. X. (2017) · Oncotarget · doi:10.18632/oncotarget.15316 · Cited by 30
Islam, S., Qi, W., Morales, C., Cooke, L. S., Spier, C. M., Weterings, E., & Mahadevan, D. (2017) · Molecular Cancer Therapeutics · doi:10.1158/1535-7163.mct-17-0089 · Cited by 29
“Moreover, HCK is a target of the BTK inhibitor ibrutinib (29, 46), providing a strong rationale for combination therapy of alisertib with ibrutinib to inhibit BCR signaling.”
Integrating novel drugs to chemoimmunotherapy in diffuse large B-cell lymphoma
Chiappella, A., Santambrogio, E., Castellino, A., Nicolosi, M., & Vitolo, U. (2017) · Expert Review of Hematology · doi:10.1080/17474086.2017.1350164 · Cited by 31
“Most adverse events were of grade 1–2 and self-limited and no dose-limiting toxicity occurred [36].”
Background
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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