Phase I/II study of tirabrutinib, a second-generation Bruton's tyrosine kinase inhibitor, in relapsed/refractory primary central nervous system lymphoma

Abstract

Background: The safety, tolerability, efficacy, and pharmacokinetics of tirabrutinib, a second-generation, highly selective oral Bruton's tyrosine kinase inhibitor, were evaluated for relapsed/refractory primary central nervous system lymphoma (PCNSL).

Methods: Patients with relapsed/refractory PCNSL, Karnofsky performance status ≥70, and normal end-organ function received tirabrutinib 320 and 480 mg once daily (q.d.) in phase I to evaluate dose-limiting toxicity (DLT) within 28 days using a 3 + 3 dose escalation design and with 480 mg q.d. under fasted conditions in phase II.

Results: Forty-four patients were enrolled; 20, 7, and 17 received tirabrutinib at 320, 480, and 480 mg under fasted conditions, respectively. No DLTs were observed, and the maximum tolerated dose was not reached at 480 mg. Common grade ≥3 adverse events (AEs) were neutropenia (9.1%), lymphopenia, leukopenia, and erythema multiforme (6.8% each). One patient with 480 mg q.d. had grade 5 AEs (pneumocystis jirovecii pneumonia and interstitial lung disease). Independent review committee assessed overall response rate (ORR) at 64%: 60% with 5 complete responses (CR)/unconfirmed complete responses (CRu) at 320 mg, 100% with 4 CR/CRu at 480 mg, and 53% with 6 CR/CRu at 480 mg under fasted conditions. Median progression-free survival was 2.9 months: 2.1, 11.1, and 5.8 months at 320, 480, and 480 mg under fasted conditions, respectively. Median overall survival was not reached. ORR was similar among patients harboring CARD11, MYD88, and CD79B mutations, and corresponding wild types.

Conclusion: These data indicate favorable efficacy of tirabrutinib in patients with relapsed/refractory PCNSL.

Trial registration: JapicCTI-173646.

Keywords: CARD11; MYD88; Bruton’s tyrosine kinase; primary central nervous system lymphoma; tirabrutinib.

Fig. 1

(A) Maximum change in the SPD, (B) swimmer plot of overall response rate, (C) PFS and (D) OS in all patients, and (E) PFS and (F) OS by tirabrutinib dose during the study. SPD, sum of the product of the greatest diameters.

Fig. 2

(A) Mean plasma concentration of tirabrutinib on day 28 of cycle 1. Pharmacokinetic data on day 28 in 1 out of 6 patients at the 480 mg fasted group in the pharmacokinetic analysis were unavailable. Error bars indicate standard deviation. (B) Mean CSF concentration of tirabrutinib. Data in 1 patient on day 1 and 2–4 hours after dose on day 2 were unavailable. Error bars indicate standard deviation.