Does tolerance of prior BTKi therapy or specific agent used (e.g., ibrutinib, acalabrutinib) influence your starting dose of pirtobrutinib?  

Not really. I generally start pirtobrutinib at the standard dose of 200 mg daily.

The BRUIN trial did not recommend upfront dose reduction for pirtobrutinib in patients who were exposed to cBTKi before. For patients who we think are still appropriate for BTK inhibitor therapy, we typically start with the full dose of pirtobrutinib in our practice. However, patients who experience...