A multicenter, open-label, phase II study of tirabrutinib (ONO/GS-4059) in patients with Waldenström's macroglobulinemia.

Tirabrutinib is a second-generation Bruton's tyrosine kinase inhibitor with greater selectivity than ibrutinib. Here we conducted a multicenter, phase II study of tirabrutinib in patients with treatment-naive (Cohort A) or with relapsed/refractory (Cohort B) Waldenstrom's macroglobulinemia (WM). Patients were treated with tirabrutinib 480 mg once daily. The primary endpoint was major response rate (MRR, ≥ partial response). Secondary endpoints included overall response rate (ORR, ≥ minor response), time to major response (TTMR), progression-free survival (PFS), overall survival (OS), and safety. Twenty-seven (18 in Cohort A; 9 in Cohort B) patients were enrolled. The median age was 71 years, and the median serum immunoglobulin M level was 3,600 mg/dL. Among the patients, 96.2% had MYD88L265P mutation. MRR and ORR were 88.9% and 96.3%, respectively (Cohort A: MRR, 88.9%; ORR, 94.4%; Cohort B: MRR, 88.9%; ORR, 100%). Median TTMR was 1.87 months. PFS and OS were not reached with a median follow-up of 6.5 and 8.3 months for Cohorts A and B, respectively. The most common adverse events (AEs) were rash (44.4%), neutropenia (25.9%), and leukopenia (22.2%), with most AEs classified as grade 1 or 2. Grade ≥3 AEs included neutropenia (11.1%), lymphopenia (11.1%), and leukopenia (7.4%). No grade 5 AEs were noted. All bleeding events were grade 1; none were associated with drug-related atrial fibrillation or hypertension. Although the follow-up duration was relatively short, the study met the primary endpoint. Therefore, tirabrutinib monotherapy is considered to be highly effective for both untreated and relapsed/refractory WM with a manageable safety profile. (JapicCTI-173646).