Ibrutinib (Imbruvica)

==General information==
Class/mechanism: Irreversible inhibitor of Bruton's tyrosine kinase (BTK), which is an enzyme that participates in the B-cell receptor (BCR) signal cascade and cytokine receptor pathways. BCR signaling is believed to promote cell proliferation, adhesion, and survival in B-cell malignancies. Inhibition of BTK interferes with the processes above, as well as B-cell chemotaxis and trafficking.Ibrutinib (Imbruvica) package insert Ibrutinib (Imbruvica) package insert (locally hosted backup)Imbruvica manufacturer's website
Pharmacyclics BTK inhibitor website
Route: PO
Extravasation: n/a
For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias or the prescribing information.
==Resistance mechanisms==
# Woyach JA, Furman RR, Liu TM, Ozer HG, Zapatka M, Ruppert AS, Xue L, Li DH, Steggerda SM, Versele M, Dave SS, Zhang J, Yilmaz AS, Jaglowski SM, Blum KA, Lozanski A, Lozanski G, James DF, Barrientos JC, Lichter P, Stilgenbauer S, Buggy JJ, Chang BY, Johnson AJ, Byrd JC. Resistance mechanisms for the Bruton's tyrosine kinase inhibitor ibrutinib. N Engl J Med. 2014 Jun 12;370(24):2286-94. Epub 2014 May 28. link to original article link to PMC article EuroPMC
==Significant side effects==
===Cardiovascular===
# Review: Leong DP, Caron F, Hillis C, Duan A, Healey JS, Fraser G, Siegal D. The risk of atrial fibrillation with ibrutinib use: a systematic review and meta-analysis. Blood. 2016 Jul 7;128(1):138-40. Epub 2016 May 31. link to original article EuroPMC
# Dickerson T, Wiczer T, Waller A, Philippon J, Porter K, Haddad D, Guha A, Rogers KA, Bhat S, Byrd JC, Woyach JA, Awan F, Addison D. Hypertension and incident cardiovascular events following ibrutinib initiation. Blood. 2019 Nov 28;134(22):1919-1928. link to original article link to PMC article EuroPMC
===Hematologic===
# Review: Caron F, Leong DP, Hillis C, Fraser G, Siegal D. Current understanding of bleeding with ibrutinib use: a systematic review and meta-analysis. Blood Adv. 2017 May 9;1(12):772-778. eCollection 2017 May 9. Review. link to original article link to PMC article EuroPMC
===Infectious===
# Review: Tillman BF, Pauff JM, Satyanarayana G, Talbott M, Warner JL. Systematic review of infectious events with the Bruton tyrosine kinase inhibitor ibrutinib in the treatment of hematologic malignancies. Eur J Haematol. 2018 Apr;100(4):325-334. Epub 2018 Feb 6. link to original article EuroPMC
# Ghez D, Calleja A, Protin C, Baron M, Ledoux MP, Damaj G, Dupont M, Dreyfus B, Ferrant E, Herbaux C, Laribi K, Le Calloch R, Malphettes M, Paul F, Souchet L, Truchan-Graczyk M, Delavigne K, Dartigeas C, Ysebaert L; on behalf on the French Innovative Leukemia Organization (FILO) CLL group. Early-onset invasive aspergillosis and other fungal infections in patients treated with ibrutinib. Blood. 2018 Apr 26;131(17):1955-1959. Epub 2018 Feb 1. link to original article EuroPMC
==Diseases for which it is established (work in progress)==
*Chronic lymphocytic leukemia
*Graft versus host disease
*Waldenström macroglobulinemia
==Diseases for which it is used==
*Diffuse large B-cell lymphoma
*Follicular lymphoma
*Mantle cell lymphoma
*Marginal zone lymphoma
*T-cell prolymphocytic leukemia
==Patient drug information==
*Ibrutinib (Imbruvica) package insert
*Ibrutinib (Imbruvica) patient drug information (Chemocare)Ibrutinib (Imbruvica) patient drug information (Chemocare)
*Ibrutinib (Imbruvica) patient drug information (UpToDate)Ibrutinib (Imbruvica) patient drug information (UpToDate)
==History of changes in FDA indication==
===Chronic graft versus host disease (cGVHD)===
*2017-08-02: FDA indication expanded for the treatment of adult patients with chronic graft versus host disease (cGVHD) after failure of one or more lines of systemic therapy. (Based on PCYC-1129-CA)
*2022-08-24: Approved for pediatric patients at least 1 year of age with chronic graft versus host disease (cGVHD) after failure of 1 or more lines of systemic therapy. (Based on iMAGINE)
===Chronic lymphocytic leukemia===
*2014-02-12: Granted accelerated approval for the treatment of patients with chronic lymphocytic leukemia (CLL) who have received at least one prior therapy. (Based on PCYC-1102 relapsed, RESONATE, HELIOS)
**2014-07-28: Converted to regular approval and approval expanded to include patients with chronic lymphocytic leukemia (CLL) who carry a deletion in chromosome 17 (17p deletion). (Based on RESONATE and iLLUMINATE)
*2016-03-04: Approval expanded for the treatment of patients with chronic lymphocytic leukemia (CLL). (Based on RESONATE-2 and HELIOS)
*2020-04-21: Approval expanded to include its combination with rituximab for the initial treatment of adult patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). (Based on ECOG E1912)
===Mantle cell lymphoma - WITHDRAWN===
*2013-11-13: Accelerated approval for the treatment of patients with mantle cell lymphoma (MCL) who have received at least one prior therapy. (Based on PCYC-1104-CA)
**2023-05-18: Accelerated approval for the treatment of patients with mantle cell lymphoma (MCL) who have received at least one prior therapy withdrawn.
===Marginal zone lymphoma - WITHDRAWN===
*2017-01-18: Accelerated approval for treatment of patients with marginal zone lymphoma (MZL) who require systemic therapy and have received at least one prior anti-CD20-based therapy. (Based on PCYC-1121-CA)
**2023-05-18: Accelerated approval for treatment of patients with marginal zone lymphoma (MZL) who require systemic therapy and have received at least one prior anti-CD20-based therapy withdrawn.
===Waldenström macroglobulinemia===
*2015-01-29: FDA approval expanded for the treatment of patients with Waldenström’s macroglobulinemia (WM). (Based on DFCI 12-015 and iNNOVATE)
==History of changes in EMA indication==
*2014-10-21: Initial authorization
==History of changes in Health Canada indication==
*2015-07-28: Initial notice of compliance with conditions
*2017-09-12: Conditions were met
==History of changes in PMDA indication==
*2016-03-26: Initial approval for the treatment of relapsed or refractory chronic lymphocytic leukemia/small lymphocytic lymphoma.
*2016-12-02: New additional indication and a new dosage for the treatment of relapsed or refractory mantle cell lymphoma.
*2018-07-02: New additional indication for the treatment of chronic lymphocytic leukemia (including small lymphocytic lymphoma).
*2021-09-27: new indication and a new dosage for the treatment of chronic graft-versus-host disease after hematopoietic stem cell transplantation (for use when steroid drugs are not sufficiently effective).
==Also known as==
*Code names: CRA-032765, PCI-32765
*Brand names: Bdbrut, Butinib, Emlutini, Ibrunat, Ibrunib, Ibrushil, Ibrutix, Ibruxen, Imbrutaj, Imbruvica, Lucibru, Nitib
==References==
Category:Drugs
Category:Mutation-specific medications
Category:Oral medications
Category:BTK inhibitors
Category:EGFR inhibitors
Category:ITK inhibitors
Category:TEC inhibitors
Category:TXK inhibitors
Category:Chronic lymphocytic leukemia medications
Category:Diffuse large B-cell lymphoma medications
Category:Follicular lymphoma medications
Category:Graft versus host disease medications
Category:Mantle cell lymphoma medications
Category:Marginal zone lymphoma medications
Category:T-cell prolymphocytic leukemia medications
Category:Waldenström macroglobulinemia medications
Category:FDA approved in 2013
Category:EMA approved in 2014
Category:Health Canada approved in 2015
Category:PMDA approved in 2016
Category:WHO Essential Cancer Medicine