What should be the next step of treatment after resistance to ibrutinib/Eco?

With the widespread use of ibrutinib/Ibrutinib (Ibrutinib) in a variety of B cell-related hematological tumors, some patients with chronic lymphocytic leukemia may face weakened efficacy or even drug resistance after long-term treatment. In clinical practice, it is generally believed that ibrutinib resistance does not mean that treatment options have been exhausted, but rather prompts the need to re-evaluate the biological characteristics of the disease and treatment strategies. First of all, doctors usually determine whether drug resistance is disease progression or short-term fluctuation through comprehensive evaluation at the imaging, hematological and molecular levels, so as to avoid premature replacement of treatment options.

After drug resistance is confirmed, the next step of treatment often revolves around "more precise inhibition of the same pathway" or "switching the treatment mechanism." Some patients may consider switching to a new generation of BTK inhibitors. These drugs are optimized in terms of target selectivity and tolerability, which help to sustain the inhibitory effect of the BTK pathway to a certain extent. For patients who are no longer suitable for continued BTK inhibitory therapy, guidelines prefer to choose targeted drugs with different mechanisms of action, such as controlling disease progression by interfering with B cell apoptosis pathways or immune regulatory pathways.

In addition, for patients whose condition changes rapidly or who have high-risk characteristics, doctors may also evaluate whether combined treatment or staged intensive treatment is needed based on the patient's physical condition. Throughout the process, the treatment goal often shifts from"quick relief" to "long-term control and balance of quality of life." It needs to be emphasized that treatment options after ibrutinib resistance are highly individualized. Patients should avoid stopping the drug on their own or frequently changing regimens, and formulate the next treatment plan under the guidance of a doctor to achieve more stable and lasting disease control.

Reference materials:https://www.imbruvica.com/