Pirtobrutinib Versus Ibrutinib in Treatment-Naïve and Relapsed/Refractory Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma.

What was studied

This was a head-to-head randomised trial of pirtobrutinib (PIR) and ibrutinib (IBR). It enrolled people with chronic lymphocytic leukemia or small lymphocytic lymphoma (CLL/SLL). PIR is a newer BTK inhibitor. 662 patients were assigned 1:1 to one drug. None had taken a BTK inhibitor before. Some were new to treatment. Some had relapsed or resistant disease. The main outcome was overall response rate, judged by an independent committee. The aim was to show PIR was not worse, called noninferiority.

What they found

The trial met its main goals. Response was 87.0 with PIR and 78.5 with IBR. These are shares of patients. In relapsed or resistant disease (437 patients), it was 84.0 against 74.8. In 225 patients new to treatment, it was 92.9 against 85.8. Time without progression favoured PIR overall, with a hazard ratio of 0.57. In newly treated patients it was 0.24. Atrial fibrillation or flutter and high blood pressure were less common with PIR.

What it means for patients

The authors say PIR was not worse than IBR for response. They say early progression data look better, mainly in newly treated patients. They also report lower rates of atrial fibrillation and high blood pressure.

Why it is not certain yet

Progression results are early. The trial was built to test response, not survival. In relapsed disease, the range for progression included no difference. Overall survival is not given in the abstract. The abstract does not give long-term safety data.

Source

Pirtobrutinib Versus Ibrutinib in Treatment-Naïve and Relapsed/Refractory Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma.

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