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The National Institute for Health and Care Excellence (NICE) has recommended a tablet to treat some forms of chronic lymphocytic leukaemia (CLL), which can be taken at home, for use on the NHS in England.
In draft guidance published on 17 April 2026, NICE approved pirtobrutinib (Jaypirca; Eli Lilly), a non-covalent Bruton’s tyrosine kinase inhibitor (BTKi), taken once daily as a 200mg dose, for patients with recurrent CLL — who have already been given a covalent BTKi — and for who further covalent BTKi treatment is not suitable.
Standard treatment for these patients would be venetoclax (Venclexta; AbbVie and Genentech) alone or venetoclax plus rituximab (Rituxan; Genentech and Biogen), the draft guidance said. People who have already tried a venetoclax regimen and a covalent BTKi would be given idelalisib plus rituximab as standard, it added.
In a press release published alongside the draft guidance, NICE said that pirtobrutinib, which could benefit around 200 people in England with CLL, “offers a new option for people at a potentially challenging point in their treatment where their cancer has stopped responding to existing therapies or if they cannot tolerate them”.
According to the draft guidance, indirect evidence, which compared taking pirtobrutinib with venetoclax alone or venetoclax plus rituximab, showed the two regimens do not differ in the length of time before a patient’s symptoms get worse.
It also noted that clinical trial evidence showed that taking pirtobrutinib gives people longer before their condition gets worse compared with either idelalisib (Zydelig; Gilead Sciences) plus rituximab or bendamustine plus rituximab.
In addition, the draft guidance said the results of a cost-effectiveness analysis revealed that the costs for pirtobrutinib are similar to, or lower than, costs for venetoclax alone or venetoclax plus rituximab.
However, since there is “not enough evidence to support a cost-effectiveness comparison against covalent BTKis”, pirtobrutinib can be used only if further treatment with a BTKi is not clinically suitable, NICE said.
Helen Knight, director of medicines evaluation at NICE, said: “This recommendation means that pirtobrutinib can offer some patients a further option that can delay their disease getting worse, while being taken at home and fitting more easily into their everyday life.”
Commenting on the recommendation, Tejal Gorasia, principal cancer pharmacist at Milton Keynes University Hospital NHS Foundation Trust, said: “Patients who have progressed on, or are intolerant to, BTKi often face limited and more burdensome options, so the availability of an effective oral therapy at this stage is particularly valuable.
“Introducing an additional oral option before the need to move to intravenous therapies may help to extend the sequence of well-tolerated treatments. This is especially relevant in a relapsing-remitting condition, such as CLL, where preserving quality of life, alongside disease control, is a key goal.”
She added: “[From a patient/carer perspective], a treatment that can be taken at home reduces the need for frequent hospital visits, which can be both physically and psychologically taxing. It also offers individuals greater autonomy and flexibility in managing their condition, which is an important but sometimes under-recognised aspect of cancer care.
“From a healthcare system perspective, the use of an oral agent, such as pirtobrutinib, may help alleviate pressure on day units and aseptic preparation services, which are already operating under significant strain”.
David Allsup, professor of haematology at Hull York Medical School at the University of Hull, said: “Pirtobrutinib belongs to a new class of drugs called non-covalent BTKis. Such agents are effective in the treatment of CLL that has relapsed after previous treatments and was found to be superior to other treatments currently used in this population of patients.
“Pirtobrutinib is an oral medication, which reduces the need to attend the hospital for infusional treatment regimens. This represents a new treatment option for those with the most difficult to treat types of CLL.”
A consultation on the draft guidance closes on 11 May 2026.
