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Can ibrutinib be stopped safely?

Medically reviewed by Sally Chao, MD. Last updated on Oct 1, 2021.

Official answer

by Drugs.com

Stopping ibrutinib can result in a disease flare-up in patients with chronic lymphocytic leukemia (CLL). A 2020 study in The Oncologist found that approximately 25% of ibrutinib patients with a median interruption period of 8 days experienced a flare or rapid CLL progression.

Disease flares are more likely to occur in patients who have been taking ibrutinib for 24 months or longer.

Patients with a more progressive stage of disease are more likely to experience a flare.

Symptoms of a disease flare can include body aches, painful lymph nodes, fatigue, fever, night sweats and abdominal pain.

Once ibrutinib treatment is resumed, flares usually resolve.

Corticosteroids have been found to be an effective option to combat the symptoms of disease flares.
Flares do not appear to be caused by lowering the dose of ibrutinib.

However, temporary stoppages of treatment are common in patients with CLL. At least 40% of patients experience a temporary interruption of their treatment, according to researchers in The Oncologist. Most often, ibrutinib will be stopped due to side effects or a medical procedure. Ibrutinib is contraindicated in surgical patients due to the risk of bleeding.

Other common reasons for stopping include:

  • Progression of disease
  • Richter’s transformation
  • Neutropenia
  • Drug interactions
  • Treatment toxicities

A 2017 study in Hematological Oncology notes that:

The median overall survival rate of patients after completely stopping ibrutinib due to a non-infectious adverse event was 245 days (approximately 8 months).

Patients with progressive CLL had a reduced median survival rate of 33 days after completely stopping ibrutinib.

References
  1. Hampel PJ, Call TG, Rabe KG, et al. Disease flare during temporary interruption of ibrutinib therapy in patients with chronic lymphocytic leukemia. Oncologist. 2020;25:974–980. https://doi.org/10.1634/theoncologist.2020-0388.
  2. Hampel PJ, Ding W, Call TG, et al. Rapid disease progression following discontinuation of ibrutinib in patients with chronic lymphocytic leukemia treated in routine clinical practice. Leuk Lymphoma. 2019;60(11):2712-2719. https://doi.org/10.1080/10428194.2019.1602268.
  3. Follows GA, UK CLL Forum. Outcomes of patients post ibrutinib treatment for relapsed/refractory CLL: A UK and Ireland analysis. Hematological Oncology. 2017;35:237–238. https://onlinelibrary.wiley.com/doi/full/10.1002/hon.2438_100.

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