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.