SOHO 2026 | Phase I/II BRUIN study: can pirtobrutinib maintain disease stability in R/R follicular lymphoma?

We’ve learned over the years that BTK inhibitors, which initially showed efficacy in CLL and mantle cell, that they actually do work in follicular lymphoma as well. And there is actually one approved BTK inhibitor called zanubrutinib. It’s approved in relapsed/refractory follicular lymphoma in combination with a CD20 antibody. As part of the BRUIN study, they allowed patients with relapsed/refractory follicular to get pirtobrutinib as a single agent. And what we found is that this very safe, generally well-tolerated non-covalent BTK inhibitor worked, as you mentioned, in about half the patients. And while the median PFS wasn’t super exciting, patients on BTK inhibitors sometimes can have slow relapse. And so you can actually maintain patients on this drug. In fact, my longest patient with follicular, who’s, you know, as part of the BRUIN study, and one, is nearly four plus years on pirtobrutinib as a single agent. So what this tells you is that while BTK inhibitors may not completely eradicate the disease, disease stabilization in a problem like follicular lymphoma is okay and then you can maintain a high quality of life with controlled disease which is why you saw the treatment duration being longer than the median progression-free survival. Now what does that say about sequencing? I think it tells you that this drug can be used if they have, you know, seen other therapies and that you might actually get greater patient benefit than just an endpoint like progression-free survival. And so quality of life matters. So in older patients, frailer patients, being able to give an oral therapy taken once a day with a fairly favorable side effect profile, if we can provide them stable disease and a high quality of life, that can be a good outcome in follicular.

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