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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

      Highlights

      • Ibrutinib (560 mg/day) showed a significant clinical activity in R/R primary central nervous system lymphoma and primary vitreoretinal lymphoma.
      • The intention-to-treat overall response rate was 52% after two 28-day cycles with activity in the brain, eyes and cerebrospinal fluid.
      • Responses were observed even in the absence of CD79B and MYD88 mutation.
      • The median progression-free survival was 4.8 months (95% confidence interval [CI]; 2.8–12.7).
      • Pulmonary aspergillosis occurred in 2 patients (4%). No fatal haemorrhage occurred.

      Abstract

      Background

      Primary central nervous system lymphomas (PCNSLs) are mainly diffuse large B-cell lymphomas (DLBCLs) of the non-germinal centre B-cell subtype, with unmet medical needs. This study aimed to evaluate the efficacy and toxicity of ibrutinib in DLBCL-PCNSL

      Patients and methods

      This prospective, multicentre, phase II study involved patients with relapse or refractory(R/R) DLBCL-PCNSL or primary vitreoretinal lymphoma. The treatment consisted of ibrutinib (560 mg/day) until disease progression or unacceptable toxicity occurred. The primary outcome was the disease control (DC) rate after two months of treatment (P0 < 10%; P1 > 30%).

      Results

      Fifty-two patients were recruited. Forty-four patients were evaluable for response. After 2 months of treatment, the DC was 70% in evaluable patients and 62% in the intent-to-treat analysis, including 10 complete responses (19%), 17 partial responses (33%) and 5 stable diseases (10%). With a median follow-up of 25.7 months (range, 0.7–30.5), the median progression-free and overall survivals were 4.8 months (95% confidence interval [CI]; 2.8–12.7) and 19.2 months (95% CI; 7.2-NR), respectively. Thirteen patients received ibrutinib for more than 12 months. Two patients experienced pulmonary aspergillosis with a favourable (n = 1) or fatal outcome (n = 1). Ibrutinib was detectable in the cerebrospinal fluid (CSF). The clinical response to ibrutinib seemed independent of the gene mutations in the BCR pathway.

      Conclusion

      Ibrutinib showed clinical activity in the brain, the CSF and the intraocular compartment and was tolerated in R/R PCNSL. The addition of ibrutinib to standard methotrexate-base induction chemotherapy will be further evaluated in the first-line treatment.

      Clinical trial number

      Keywords

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