Dr. Byrd on Future Directions With Acalabrutinib in CLL

John C. Byrd, MD, D. Warren Brown Chair of Leukemia Research, Distinguished University Professor of Medicine, Medicinal Chemistry and Veterinary Biosciences, senior advisor, Cancer Experimental Therapeutics, The Ohio State University Comprehensive Cancer Center–James, discusses future directions with acalabrutinib (Calquence) in chronic lymphocytic leukemia (CLL).

During the 2021 ASCO Annual Meeting, findings from the phase 3 ELEVATE-RR trial (NCT02477696) were presented, showing the first head-to-head data of the BTK inhibitors acalabrutinib vs ibrutinib (Imbruvica) in CLL. The results demonstrated noninferiority with acalabrutinib compared with ibrutinib in patients with previously treated CLL.

Going forward, combination strategies with acalabrutinib should be investigated, says Byrd. Moreover, studies should evaluate the utility of BTK inhibitors in patients with previously treated CLL who require proton pump inhibitors because the ELEVATE-RR trial excluded this patient subset, Byrd explains. Perhaps a novel formulation of acalabrutinib or a novel second-generation BTK inhibitor, such as zanubrutinib (Brukinsa), could be used in patients who receive proton pump inhibitors, adds Byrd.

Ultimately, combination strategies with acalabrutinib could allow patients to receive a fixed-duration therapy and then subsequently stop treatment while in remission vs receiving indefinite single-agent BTK inhibitor therapy, concludes Byrd.