Economic analysis of zanubrutinib vs. acalabrutinib in B-cell malignancies

A recent meta-analysis by Hwang et al. provided a comprehensive comparison of adverse event (AE) profiles of zanubrutinib with acalabrutinib in patients with B-cell malignancies. Specific AEs seen more commonly with acalabrutinib than zanubrutinib included infections, atrial fibrillation, diarrhea, nausea/vomiting, headaches, cough, fatigue and pyrexia. On the other hand, hematuria, neutropenia, and hypertension were observed more frequently with zanubrutinib than with acalabrutinib [1].

Relative efficacy of several treatment options in marginal zone lymphoma

Chemoimmunotherapy (CIT), immunotherapy and chemotherapy regimens are commonly used for the treatment of patients with marginal zone lymphoma. Moreover, the BTK inhibitor zanubrutinib has shown activity in the relapsed/refractory setting based on the phase II, single-arm MAGNOLIA and BGB-3111-AU-003 trials [1, 2]. Walewska et al. conducted a matching-adjusted indirect comparison (MAIC) to estimate the comparative efficacy of these treatment strategies in relapsed/refractory marginal zone lymphoma [3].

Follicular lymphoma: news on bispecific antibody treatment

In the setting of relapsed/refractory follicular lymphoma (FL), progression-free survival (PFS) deteriorates with successive relapses, which implies a high unmet need for therapies that can improve disease control and extend survival after relapse [1]. The Fc-silenced CD20 x CD3 bispecific antibody odronextamab is being investigated in patients with relapsed/refractory B-cell malignancies in the multicohort, multicenter, phase II ELM-2 study.

Innovative BCL2 inhibition: indications fanning out across B-cell malignancies

The combination of the first-generation BCL2 inhibitor venetoclax and the first-in-class BTK inhibitor ibrutinib has demonstrated efficacy in patients with chronic lymphocytic leukemia (CLL) [1], although tolerability of this regimen is limited. Next-generation agents can be expected to provide optimized toxicity profiles. The second-generation BCL2 inhibitor sonrotoclax inhibits BCL2 in a more selective and pharmacologically potent manner than venetoclax, with a shorter half-life preventing drug accumulation that might contribute to toxicity [2].

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