Real-World Tirabrutinib Use in Primary CNS Lymphoma

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. He first describes the Japanese approach to newly diagnosed PCNSL, including high-dose methotrexate-based combination therapy and consolidation strategies, with whole-brain radiotherapy increasingly avoided in older patients because of concerns regarding delayed neurotoxicity. He explains that patients are followed closely with serial MRI, allowing recurrence to sometimes be detected before clinical deterioration. Since tirabrutinib became available, its oral administration, outpatient feasibility, relatively favorable tolerability, and rapid responses have made it an important treatment option for relapsed/refractory PCNSL, particularly among older patients. Dr. Nagane contrasts this approach with methotrexate rechallenge, which may require hospitalization and can be burdensome for older patients. Dr. Nayak emphasizes the value of real-world experience in understanding treatment in broader patient populations than those typically enrolled in clinical trials. Dr. Grommes adds that real-world data from the ROSETTA study confirmed high response rates and showed median progression-free survival that was longer than observed in the original study population.