Taiwan Monitoring, Reimbursement Constraints, and Frontline Aspirations

Dr. Chieh-Lung Cheng describes his practical monitoring approach in Taiwan, where tirabrutinib is the only BTK inhibitor approved for relapsed/refractory PCNSL. Because hepatitis B is endemic, he screens and monitors for HBV reactivation with any BTK inhibitor in addition to watching for skin rash and neutropenia. He confirms that a subset of patients achieve durable remission, citing a compassionate-use patient sustaining a prolonged response, while noting that Taiwan's reimbursement policy caps the covered treatment duration, after which continued therapy requires out-of-pocket payment. He uses tirabrutinib as a bridge in fit, younger patients, planning consolidation such as stem cell transplantation or radiotherapy after the covered course, while frail patients receive monotherapy for disease control. Looking ahead, he points to frontline investigation (PROSPECT Part B combining tirabrutinib with chemoimmunotherapy such as R-MPV or MTR) and early combination data with other BTK inhibitors showing encouraging response rates, and identifies promising relapsed/refractory combination candidates including tirabrutinib plus lenalidomide, checkpoint inhibitors, or other targeted agents.