Dr. Barrientos Discusses Acalabrutinib in CLL

Jacqueline C. Barrientos, MD, associate professor, The Feinstein Institute for Medical Research, Northwell Health, discusses the role of acalabrutinib (Calquence) for patients with chronic lymphocytic leukemia (CLL).

There was an abstract presented at the 2016 ASH Annual Meeting that showed that some patients who were responding to ibrutinib (Imbruvica), but had to stop due to an intolerable side effect could be salvaged with acalabrutinib and continue to have a response. Very few of them had a significant toxicity that led to a discontinuation of acalabrutinib. As of right now, acalabrutinib is only approved in the United States for relapsed/refractory mantle cell lymphoma, but it is moving toward an approval in patients with CLL. If approved, it would then be an alternative for patients who cannot tolerate venetoclax (Venclexta).

If a patient has severe kidney disease that is high risk for tumor lysis syndrome, perhaps acalabrutinib could be a better choice than venetoclax, Barrientos suggests. If the patient has a severe intracranial bleed that leads to debilitation, Barrientos would not choose a drug like acalabrutinib, as that bleeding event may come back because the anatomy of the brain vessels is different. However, Barrientos says she would consider acalabrutinib for patients who have issues with arrhythmias that are causing them to discontinue ibrutinib, or if they have arthritis. Physicians have some preliminary data for the use of acalabrutinib in those situations.