Ibrutininb higher dose for CNS involvement – pro
The recommended starting dose for IMBRUVICA® is 420 mg, taken orally. Ibrutinib at high doses has been preliminarily studied fo CNS lymphoma. Results from a small, phase I trial presented at the 2016 ASCO Annual Meeting show that the Bruton tyrosine kinase (BTK) inhibitor ibrutinib is well tolerated in patients with recurrent/refractory primary (PCNSL) and secondary CNSL (SCNSL).
Central nervous system (CNS) involvement in chronic lymphocytic leukemia (CLL) is rare, occurring in a small percentage of patients, with reported rates ranging from 0.4% to 2% in clinical studies. However, autopsy studies suggest that CNS involvement may be underdiagnosed. When it does occur, it can manifest with a variety of neurological symptoms and requires prompt diagnosis and treatment.
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Benjamini O, Jain P, Schlette E, Sciffman JS, Estrov Z, Keating M. Chronic lymphocytic leukemia with central nervous system involvement: a high-risk disease? Clin Lymphoma Myeloma Leuk. 2013 Jun;13(3):338-41. doi: 10.1016/j.clml.2012.12.007. Epub 2013 Jan 16. PMID: 23332395; PMCID: PMC4167026.
C. Sussain et al, Ibrutinib monotherapy for relapse or refractory primary CNS lymphoma and primary vitreoretinal lymphoma: Final analysis of the phase II ‘proof-of-concept’ iLOC study by the Lymphoma study association (LYSA) and the French oculo-cerebral lymphoma (LOC) network. European Journal of Cancer Volume 117, August 2019, Pages 121-130