Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. May 24, 2024; 15(5): 587-590
Published online May 24, 2024. doi: 10.5306/wjco.v15.i5.587
Bruton’s tyrosine kinase inhibitors in primary central nervous system lymphoma: New hopes on the horizon
Leonardo S Lino-Silva, Sabrina B Martínez-Villavicencio, Luisa Fernanda Rivera-Moncada
Leonardo S Lino-Silva, Sabrina B Martínez-Villavicencio, Luisa Fernanda Rivera-Moncada, Department of Pathology Oncology, National Cancer Institute (Mexico), Tlalpan, Mexico City 14080, Mexico
Author contributions: Lino-Silva LS, Martínez-Villavicencio S, and Rivera-Moncada LF contributed to this paper; Lino-Silva LS designed the overall concept and outline of the manuscript; Martínez-Villavicencio S and Rivera-Moncada LF contributed to the discussion and design of the manuscript; Lino-Silva LS, Martínez-Villavicencio S, and Rivera-Moncada LF contributed to the writing and editing of the manuscript, and review of the literature.
Conflict-of-interest statement: All authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Leonardo S Lino-Silva, MD, MEd, PhD, Professor, Department of Department of Pathology Oncology, National Cancer Institute (Mexico), Av. San fernando 22, Sección XVI, Tlalpan, Mexico City 14080, Mexico. saul.lino.sil@gmail.com
Received: December 12, 2023
Revised: March 22, 2024
Accepted: April 17, 2024
Published online: May 24, 2024
Abstract

In this editorial, we comment on the article by Wang et al. This manuscript explores the potential synergistic effects of combining zanubrutinib, a novel oral inhibitor of Bruton’s tyrosine kinase, with high-dose methotrexate (HD-MTX) as a therapeutic intervention for primary central nervous system lymphoma (PCNSL). The study involves a retrospective analysis of 19 PCNSL patients, highlighting clinicopathological characteristics, treatment outcomes, and genomic biomarkers. The results indicate the combination’s good tolerance and strong antitumor activity, with an 84.2% overall response rate. The authors emphasize the potential of zanubrutinib to modulate key genomic features of PCNSL, particularly mutations in myeloid differentiation primary response 88 and cluster of differentiation 79B. Furthermore, the study investigates the role of circulating tumor DNA in cerebrospinal fluid for disease surveillance and treatment response monitoring. In essence, the study provides valuable insights into the potential of combining zanubrutinib with HD-MTX as a frontline therapeutic regimen for PCNSL. The findings underscore the importance of exploring alternative treatment modalities and monitoring genomic and liquid biopsy markers to optimize patient outcomes. While the findings suggest promise, the study’s limitations should be considered, and further research is needed to establish the clinical relevance of this therapeutic approach for PCNSL.

Keywords: Primary central nervous system lymphoma, Zanubrutinib, Bruton’s tyrosine kinase, Prognosis, Myeloid differentiation primary response 88 gene, Cluster of differentiation 79B gene

Core Tip: The combination of zanubrutinib with high-dose methotrexate shows promise as a therapeutic approach for primary central nervous system lymphoma (PCNSL). In this study involving 19 patients, the treatment demonstrated a notable 84.2% overall response rate with manageable adverse events. The presence of circulating tumor DNA in cerebrospinal fluid emerged as a potential tool for monitoring treatment response. These findings are optimistic, but research in larger patient groups is crucial to validate outcomes and assess long-term effects, especially in different molecular subtypes of PCNSL.