Dr. Sauter on the Potential Role of BTK Inhibitors in Frontline CNS Lymphoma

Craig Sauter, MD, director, Blood and Marrow Transplant Program, Hematology and Medical Oncology, the Cleveland Clinic, discusses where BTK inhibitors could fit into the frontline treatment landscape for patients with central nervous system (CNS) lymphoma and research aiming to address other unmet needs for this patient population.

An ongoing phase 1 trial (NCT02203526) sponsored by the National Cancer Institute is investigating the combination of temozolomide (Temodar), etoposide, doxorubicin, dexamethasone, ibrutinib (Imbruvica), and rituximab (Rituxan)—known as the TEDDI-R regimen—for the frontline treatment of primary CNS lymphoma.

Although later-generation BTK inhibitors that followed ibrutinib have shown to be more specific and better tolerated, BTK inhibitors have been primarily used in the relapsed/refractory setting, Sauter says, noting that focusing on prospective investigations with these agents remains a priority.

Outside of BTK inhibitors, other unmet needs remain to be addressed within the treatment landscape for CNS lymphoma. One issue involves the safety of autologous stem cell transplant in first remission, Sauter continues. Many of the patients who are diagnosed with CNS lymphoma are older, so these patients typically present with comorbidities or have a poor performance status, Sauter explains.

Additionally, developing more effective agents for the treatment of patients in the relapsed/refractory setting is an area that still needs to be addressed, Sauter concludes.