Dr. Erba on Selecting Between Ibrutinib and Acalabrutinib in CLL

Harry Paul Erba, MD, PhD, instructor, clinical investigator, Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, member, Duke Cancer Institute, director, Leukemia Program and Phase I Development in Hematologic Malignancies, Duke Health, discusses selecting between ibrutinib (Imbruvica) and acalabrutinib (Calquence) in chronic lymphocytic leukemia (CLL).

Findings from the phase 3 ELEVATE-RR trial (NCT02477696) demonstrated noninferior progression-free survival with acalabrutinib vs ibrutinib in patients with relapsed/refractory CLL; however, acalabrutinib was better tolerated vs ibrutinib in terms of common adverse effects (AEs), grade 3 or greater AEs, serious AEs, and treatment discontinuations from AEs.

Ibrutinib was associated with more cardiovascular events, including atrial fibrillation, flutter events, and hypertension, vs acalabrutinib. The BTK inhibitor was also associated with less diarrhea, arthralgia, and any-grade bleeding events compared with ibrutinib. However, acalabrutinib was associated with a greater incidence of other AEs, including headache.

Although most AEs seen with either BTK inhibitor were grade 1 or 2, toxicity is an important consideration for treatment selection with chronic therapies because even low-grade toxicities can impede on patients’ quality of life, Erba concludes.