Dr. Siddiqi on the Role of Acalabrutinib in Frontline CLL

Tanya Siddiqi, MD, director of the Chronic Lymphocytic Leukemia Program at the Toni Stephenson Lymphoma Center, and an associate clinical professor of the Division of Lymphoma, Department of Hematology & Hematopoietic Cell Transplantation, at City of Hope, discusses the role of acalabrutinib (Calquence) as a frontline treatment for patients with chronic lymphocytic leukemia (CLL). 

Acalabrutinib was previously examined in a phase 3 ELEVATE-TN trial (NCT02475681) with or without obinutuzumab (Gazyva) vs chlorambucil-based therapy in combination with obinutuzumab, according to Siddiqi. Unsurprisingly, the acalabrutinib regimen yielded a significant improvement in outcomes, Siddiqi says.

Currently, the biggest question is how to decide between acalabrutinib and ibrutinib (Imbruvica), which has had longer follow-up and was approved by FDA. Both agents are good options for patients with CLL in the frontline setting, though acalabrutinib is beginning to be utilized more often, she says. This is because the agent may have fewer adverse effects (AEs), such as atrial fibrillation and hypertension.

Atrial fibrillation occurs in approximately 10% to 14% of patients treated with ibrutinib, whereas acalabrutinib has not yielded a notable amount of these AEs. This could reassure patients and doctors alike that acalabrutinib may be better tolerated, Siddiqi concludes.