Tirabrutinib in Relapsed/Refractory Primary CNS Lymphoma

Dr. Chieh-Lung Cheng describes the impact of tirabrutinib availability on the management of relapsed/refractory primary CNS lymphoma (PCNSL) in Taiwan. He notes that patients with refractory disease may present with significant neurologic deficits and poor performance status, while advanced age and frailty can limit the feasibility of intensive chemoimmunotherapy. In this setting, the availability of an approved targeted treatment has shifted clinical practice toward an oral therapeutic option that can be initiated in the outpatient setting. Dr. Cheng explains that, under Taiwan's reimbursement framework, tirabrutinib monotherapy is primarily incorporated after failure of high-dose methotrexate-based first-line therapy, with treatment covered for up to 9 months. He highlights the rapid clinical and radiographic responses observed in practice, with responses typically emerging within approximately 1 month. For fit patients who have not previously undergone autologous stem cell transplantation, Dr. Cheng describes tirabrutinib as a potential bridge to subsequent consolidation, while for frail patients it may provide disease control while helping preserve quality of life.