Experts debate BTK inhibitors for primary CNS lymphoma, sharing trial and real-world insights on tirabrutinib and options for relapsed disease.
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Global Perspectives on BTK Inhibition in Primary CNS Lymphoma: Real-World Experience from Japan and Taiwan
This program explores the evolving treatment landscape for primary CNS lymphoma (PCNSL), with a focus on the clinical rationale, real-world experience, and emerging role of Bruton tyrosine kinase (BTK) inhibition. Dr. Lakshmi Nayak moderates a discussion with Dr. Christian Grommes, Dr. Motoo Nagane, and Dr. Jerome Cheng, bringing together perspectives from the United States, Japan, and Taiwan. The discussion reviews the biological features of PCNSL that support BTK inhibition, including frequent alterations affecting the B-cell receptor signaling pathway, as well as the challenges of treating disease within the central nervous system. Faculty discuss the evolution of BTK inhibitors, clinical trial findings, CNS penetration, treatment selection, response and durability, and practical management of adverse events. Dr. Nagane and Dr. Cheng provide insights from clinical practice in Japan and Taiwan, where tirabrutinib is approved for relapsed/refractory PCNSL. The faculty also consider opportunities for BTK inhibitors in combination and earlier-line settings, while highlighting remaining questions regarding durability and long-term disease control. The program is intended to provide an international perspective on the role of BTK inhibition in PCNSL.
Global Perspectives on BTK Inhibition in Primary CNS Lymphoma: Real-World Experience from Japan and Taiwan
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Experts unpack BTK inhibitor use for relapsed primary CNS lymphoma, sharing Japan and Taiwan real‑world data, trials, and tirabrutinib insights.
Dr. Christian Grommes discusses the emerging role of BTK inhibitors in relapsed/refractory primary CNS lymphoma (PCNSL), focusing on U.S. off-label use and ongoing clinical investigation.
Dr. Chieh-Lung Cheng describes the impact of tirabrutinib availability on the management of relapsed/refractory primary CNS lymphoma (PCNSL) in Taiwan.
Dr. Motoo Nagane discusses the evolving treatment pathway for primary CNS lymphoma (PCNSL) in Japan following the approval of tirabrutinib for relapsed or refractory disease.
Dr. Lakshmi Nayak transitions the discussion to the evolution of the BTK inhibitor class, the program's second module.
Dr. Christian Grommes revisits the early ibrutinib experience, when nearly every B-cell malignancy appeared responsive to BTK inhibition, and recalls the setback in non-CNS diffuse large B-cell lymphoma, where responses and progression-free survival were disappointing.
Dr. Lakshmi Nayak asks Dr. Motoo Nagane, as a neurosurgeon and neuro-oncologist, about the pharmacologic importance of CNS penetration.
Dr. Chieh-Lung Cheng addresses where BTK inhibitors fit in relapsed/refractory PCNSL and how he selects patients, noting that in Taiwan tirabrutinib is used as monotherapy rather than in combination.
Dr. Lakshmi Nayak asks Dr. Motoo Nagane about real-world patient selection and dose maintenance in Japan, drawing on several years of post-approval experience.
Dr. Chieh-Lung Cheng describes his practical monitoring approach in Taiwan, where tirabrutinib is the only BTK inhibitor approved for relapsed/refractory PCNSL.
EP. 12: Frontline and Maintenance Directions; Interpreting Real-World Data and Infection Prophylaxis
Dr. Lakshmi Nayak turns to the future role of BTK inhibitors in frontline and maintenance therapy.
Dr. Chieh-Lung Cheng reports a gastrointestinal bleeding event in one patient that resolved with dose reduction, allowing continued therapy.
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