Head-to-Head Analysis of Acalabrutinib Vs Ibrutinib in Previously Treated CLL

EP: 1.Revolutionizing the Management of Chronic Lymphocytic Leukemia

EP: 2.Frontline BTK Inhibition in CLL: 7-Year Follow-up Data From RESONATE-2

EP: 3.4-Year Follow-up Data From ELEVATE-TN: Frontline Acalabrutinib in CLL

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EP: 4.Head-to-Head Analysis of Acalabrutinib Vs Ibrutinib in Previously Treated CLL

EP: 5.Optimal Toxicity Management With BTK Inhibitors in CLL

EP: 6.Moving the Dial on CLL Management: Sequencing Strategies and Unmet Needs

EP: 7.The Evolution of CLL Treatment

EP: 8.Rationale and Use of BTK Inhibitors as Initial Treatment for CLL

EP: 9.Frontline BTKi Therapy in CLL: The ELEVATE-TN Study 4-Year Follow-up

EP: 10.Acalabrutinib vs Ibrutinib: Head-to-Head Data in Previously Treated CLL

EP: 11.Optimal Treatment Strategies for Chronic Lymphocytic Leukemia

EP: 12.Looking Toward the Future of CLL Management

Brad S. Kahl, MD: One of the more important abstracts presented at ASCO [American Society of Clinical Oncology Annual Meeting] this year was a head-to-head trial, acalabrutinib vs ibrutinib in previously treated CLL [chronic lymphocytic leukemia]. Dr John Byrd presented this in the oral session. This was a big trial, it had over 500 patients, and patients were randomized to ibrutinib vs acalabrutinib. Acalabrutinib is a so-called second-generation BTK [Bruton tyrosine kinase] inhibitor, so this trial is called ELEVATE-RR. This was the first presentation of the results.

The 2 patient populations were perfectly well balanced for baseline characteristics. With regard to efficacy, the 2 drugs performed very similarly. There’s no difference in the progression-free survival. The median for each drug came in at 38 months. Remember, this was a relapsed/refractory population, so the efficacy isn’t as good in relapsed/refractory disease as it is in front line. At 38 months is how both drugs performed for median progression-free survival. Acalabrutinib was deemed noninferior based on that, statistically.

When you start to look at tolerability issues, you start to see some advantages to the acalabrutinib. There was less risk for atrial fibrillation and atrial flutter with acalabrutinib. There was less risk for hypertension with acalabrutinib. These were statistically significant and clinically meaningful differences. There was also a better safety profile for acalabrutinib when it comes to bleeding events, diarrhea, and arthralgia. Acalabrutinib was a little worse than ibrutinib when it comes to headache and cough. When you look at the whole data set in total and look at the whole package, the conclusion of the investigators was that acalabrutinib is preferred over ibrutinib because efficacy is comparable and tolerability is better. I agree with that conclusion.

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