Monitoring and Management of Toxicities of Novel B Cell Signaling Agents
B cell signaling agents, including ibrutinib, idelalisib, and the BCL-2 inhibitor venetoclax have become an integral part of therapy for patients with non-Hodgkin’s lymphomas. The toxicity profiles of these medications is distinct from chemoimmunotherapy. Here, we will review the mechanism of action of these drugs, their efficacy, and toxicity management.
Ibrutinib use is associated with increased risk of atrial fibrillation and bleeding which can be managed using dose interruptions and modifications. Patients on idelalisib require close clinical and frequent laboratory monitoring, particularly of liver function tests to ensure there are no serious adverse events. Monitoring for infections is important in patients on both idelalisib and ibrutinib. Venetoclax requires close clinical and laboratory monitoring to prevent significant tumor lysis.
Targeted B cell receptor therapies each have unique side effect profiles which require careful clinical monitoring. As we continue to use these therapies, optimal management strategies will continue to be elucidated.
KeywordsToxicity Ibrutinib Idelalisib Venetoclax Colitis Pneumonitis Opportunistic infections Tumor lysis Atrial fibrillation Receptor signaling
Compliance with Ethical Standards
Conflict of Interest
Joanna Rhodes declares that she has no conflict of interest.
Anthony Mato has received research funding from Portola, AbbVie, Acerta, DTRM, TG Therapeutics, Pharmacyclics, and Regeneron; has received compensation from AbbVie, AstraZeneca, Janssen, and Kite for service as a consultant; and has served on advisory boards for Gilead, TG Therapeutics, and Celgene.
Jeff P. Sharman has received research funding from AbbVie, Gilead, Acerta, TG Therapeutics, and Pharmacyclics; has received compensation from AbbVie, Gilead, Acerta, TG Therapeutics, and Pharmacyclics for service as a consultant; and has served on an advisory board for Genentech.
Human and Animal Rights and Informed Consent
This article contains studies with human or animal subjects performed by the authors.
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