Asad Dean, MD, is a physician at Texas Oncology and an assistant professor in the Division of Hematology/Oncology at UT Southwestern Medical Center.

, which provides oncology professionals with the resources and information they need to provide the best patient care. In both digital and print formats, 

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In today’s episode, we had the pleasure of speaking with Asad Dean, MD, about treatment selection for patients with chronic lymphocytic leukemia (CLL) in the second-line setting. Dean is a physician at the Texas Oncology-Fort Worth Cancer Center.

In our exclusive interview, Dean discussed the roles of covalent Bruton tyrosine kinase (BTK) and BCL-2 inhibitors in managing CLL. He highlighted the importance of molecular profiling for treatment rechallenge decisions and the potential for resistance mutations in this disease. He also noted the role of pirtobrutinib (Jaypirca) in overcoming treatment resistance, along with clinical signs indicating that patients may need a therapy change. Dean also mentioned the high response rates seen with CAR T-cell therapy in patients with CLL and explained the possibility of combination regimens in CLL. Additionally, he expressed optimism about BTK degraders and bispecific antibodies.

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Podcasts

Dean discusses the role of BTK inhibitors in the management of CLL and the importance of molecular profiling for treatment rechallenge decisions.

The Evolving Role of Noncovalent BTK Inhibition Informs CLL Treatment Selection: With Asad Dean, MD

Dr Dean on the Role for Pirtobrutinib in Second-Line CLL

“Based on the NCCN [guidelines] as a platform and foundation, I [would] move on to a noncovalent, reversible BTK inhibitor like pirtobrutinib following disease progression on a covalent BTK inhibitor.”

Asad Dean, MD, a physician at Texas Oncology and an assistant professor in the Division of Hematology/Oncology at UT Southwestern Medical Center, discusses the role of pirtobrutinib (Jaypirca) for the second-line treatment of patients with relapsed/refractory chronic lymphocytic leukemia (CLL). 

Dean began by stating that he sees pirtobrutinib playing a role in the second-line setting for patients with CLL. The agent is currently indicated by the FDA for the treatment of adult patients with CLL or small lymphocytic lymphoma (SLL) who have received at least 2 prior lines of therapy, including a BTK inhibitor and a BCL2 inhibitor, he noted. Data from the phase 1/2 BRUIN trial (NCT03740529), which supported the agent’s approval in this setting, showed that patients treated with pirtobrutinib (n = 108) experienced an overall response rate of 72% (95% CI, 63%-80%) and a median duration of response of 12.2 months (95% CI, 9.3-14.7). According to the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology for CLL/SLL, pirtobrutinib is also recommended as a second-line therapy in the event of resistance or intolerance to prior covalent BTK inhibitor–based regimens, he added.

Dean added that the flexibility offered by the inclusion of pirtobrutinib in the NCCN guidelines benefits patients since there are currently no FDA approvals for a frontline BTK inhibitor and BCL2 inhibitor combination regimen in CLL. This approach is also recognized by the NCCN guidelines, he said. It is advantageous to use the NCCN guidelines as a foundation to allow the use of a noncovalent, reversible BTK inhibitor such as pirtobrutinib following disease progression on a first-line covalent BTK inhibitor, he concluded.

Videos

Asad Dean, MD, discusses the role of pirtobrutinib in second-line CLL.

Asad Dean, MD

Articles

The Evolving Role of Noncovalent BTK Inhibition Informs CLL Treatment Selection: With Asad Dean, MD

Dr Dean on the Role for Pirtobrutinib in Second-Line CLL