Highlights

I tell my [first-line] patients that when I put them on ibrutinib to expect it to work for at least 4–5 years, that may be underestimating it. I use five years as sort of my ballpark median.

The [ibrutinib/Imbruvica] side effects that I call not deal breakers are rash, joint ache, muscle ache, joint pain. Patients get that and I tell them, if the treatment is working and the side effects are tough to tolerate, then you may be best to put up with it and my patients put up with it if the drug is working. The two side effects where we will stop are game changers because they are life threatening, will be bleeding or AFib, and we do get that. Like I said, 10–15% of my patients will go off treatment from a tolerability issue, the majority develop AFib and then they have to stop.

Acalabrutinib [Calquence], right now I’m using it for patients with AFib or a history of AFib. I do see older patients, and older patients will have cardiac issues, so I find myself in those two places. If the patient has a history of AFib, now that acala is available then I go to acala. If they develop AFib while on ibrutinib, and I have a number of patients who develop AFib while on ibrutinib, if the treatment has been working then I will switch to acala to see if we can avoid the AFib. I would say about 15%, 15–20% [of my patients get acalabrutinib], something in that ballpark, but that number is going up. Now I’m thinking that for my older people, even if they don’t have AFib, because older people may be more susceptible to AFib, now that I have more experience with acala I might be thinking of going to acala without going to ibrutinib, even if they didn’t have AFib, as I become more comfortable with the drug.