Temporary stoppage of Ibrutinib

[CoBubby]

I need to stop IB one week pre/post surgery. Today is day 3. Has anyone started feeling reversal symptoms? I’m feeling more fatigued. Hoping my lymph nodes issues don’t return. Just curious.

[2grandsons]

I also get reversal symptoms after I’ve been without Imbruvica for 3-4 days. My lymph nodes become HUGE, I get night sweats and all of the other “B symptoms”.

Not to worry, Friend. For me things have always returned to where they were before the doses were stopped, once I’m able to start taking my dose again. It does take 5 days to a week in my case.

Feel better and stay positive!

[64lusso]

I’ve had to do the same thing for minor hand surgery twice and noticed no difference but I never had much in the way of swollen lymph’s or night sweats in my watch and wait days either.

[Skyshark]

Tumour flare is common when stopping BTKi. Getting back on the drugs will usually being it back under control.

Maybe a good time to consider a switch to a 2nd generation BTKi? Some people have had problems with tablet Acalabrutinib, Zanubrutinib is still capsules.

As everyone's response is very different. Stopping BTKi is usually in the field, not on a study there isn't a lot of information. A recent report showed that when commencing BTKi a full dose for first two cycles was critical. If stopping on a reduced dose it may be advisable to endure at least one cycle at full dose when restarting before cutting back.

ashpublications.org/hematol...

In an analysis of the RESONATE data, higher dose intensity during the first 8 weeks of therapy was associated with longer median progression-free survival (NR vs 6.9 months), and dose interruptions of ≥8 consecutive days (reported with 9 months of follow-up) were associated with a shorter median progression-free survival (10.8 months vs NR). Host-related factors may be a confounder here, because in other analyses patients with early alterations tended to have poor performance status and had a higher likelihood of permanent early discontinuation.

Then there are the converse cases where people can just stop and have a drug free holiday. (E1912 excluded patients with TP53 aberrations.)

ashpublications.org/blood/a...

Among patients on E1912 who discontinue ibrutinib for a reason other than progression, the median PFS is 2 years.