My husband has been on pirtobrutinib for one year in October. He was granted a compassionate use authorization by the FDA since it had not yet been approved by the FDA. His oncologist told him yesterday the efficacy of this drug is 12-18 months.
His journey so far has been bundamustine chemo therapy, imbrutinib, venetoclax and now pirtobrutinib, Has anyone else been on this path and now being treated post pirtobrutinib?
There is active research on what follows after venetoclax, BTK covalent (acalabrutinib, ibrutinib and zanubrutinib) and non-covalent (pirtobrutinib) therapy choices have been exhausted. In addition to a bone marrow transplant, there are clinical trial options of CAR-T and a range of other targeted therapies.
I try to keep an up to date list of new clinical treatments in my replies to this post, but it's not easy with so much happening. healthunlocked.com/cllsuppo... Your husband's oncologist has done well supporting your husband, so I expect they will continue in doing this.
Neil
Thank you Neil!
I’ve had all those except Bendamustine- I’m now having a stem cell transplant. However the doctor will decide what best suits him as there are so many new treatments becoming available. Best wishes B
Thank you for your reply! How long did the pirtobrutinib work for you?
I was on a clinical trial of a combination of Pirtobrutinib and Venetoclax for 2 years but I only had a remission of a few months. I went back on Pirtobrutinib to get me back into remission to prepare for stem cell transplant - unfortunately it didn’t work on its own so they added the Venetoclax in again.
I can certainly relate to your situation. I have relapsed on 7 different therapies, and now am on Pirtobrutinib. The general consensus is that I can expect to get about 18 months remission. So in my timeline, this would be the end of 2024 when I can expect to have to make another change (assuming I go the full 18 months). Like you, I am preparing for the NEXT treatment. There are a couple of things I have been looking at. There is a new BCL2 inhibitor in trial called Lisaftoclax, that may be able to work AFTER failing Venetoclax. I would expect there would be papers on this at ASH 2023 in December. There are two more classes of NEW CLL drugs that are in early trials that may be available. One is a BTK degrader like NX-2127 and another is a Bispecific T-cell Engager (epcoritamab). It is too early to tell whether or not they may work, but we probably will see more papers on these at ASH. I would like to keep CARt and a Transplant at the end of my list. There is also a new CARt that uses CD20 (from Mustang Bio) instead of the current CD19 approaches.
The problem that we have for heavily treated individuals is that the treatments so far (with the exception of some transplant patients) are not curative, so we bounce from one treatment to the next. Always hoping there will be a NEXT. What I am finding is that almost all of these trials are at MAJOR medical centers like Ohio State, Fred Hutchison in Seattle, MD Anderson, Dana Farber, City of Hope, Sloan Kettering, etc. So I have concluded that I may have to travel (and stay for a while) if I find a trial that I would eligible for.
Terry
I have a very similar treatment journey to your husband’s. I was diagnosed 2008, started treatment in 2011. B&R twice, venetoclax, calquence and now pirtobrutinib since this September under compassionate use. My doc told me that it may give 20 -24 months. What’s next? Doc said Clinical trial.
I am hoping another drug will be available by that time.
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WHAT NEXT?
