Javier Pinilla-Ibarz, MD, PhD

Javier Pinilla-Ibarz, MD, PhD, of Moffitt Cancer Center, Tampa, Florida, commented on this study:

“ELEVATE TN compared front-line treatment with acalabrutinib alone or in combination with obinutuzumab vs obinutuzumab/chlorambucil and showed that a second-generation Bruton’s tyrosine kinase (BTK) inhibitor was superior to standard therapy. The bottom line is that it is not possible to compare acalabrutinib alone vs in combination with obinutuzumab from these data. There appears to be a mild advantage to adding obinutuzumab to acalabrutinib, but the study is not definitive in this regard,” he said.

“The study did show that acalabrutinib offers an alternative BTK inhibitor to ibrutinib, and the drug is now approved as front-line treatment and in relapsed/refractory chronic lymphocytic leukemia (CLL). Some patients may be intolerant to ibrutinib, and the newer drug appears to have a better cardiovascular profile. If you were selecting patients for treatment with a BTK inhibitor, perhaps a patient with a cardiovascular condition or elderly patients may do better on acalabrutinib,” he suggested, “but we don’t have a direct comparison of acalabrutinib vs ibrutinib.”

He added: “The more specific BTK targeting with acalabrutinib may explain why the side effects were lower, but we need a direct comparison between these drugs.”

The ELEVATE RR trial will compare acalabrutinib vs ibrutinib in 533 patients with previously treated high-risk CLL, Dr. Pinilla-Ibarz noted. This study should provide direct comparative data between these two BTK inhibitors. Zanubrutinib will also be directly compared with ibrutinib. 

DISCLOSURE: Dr. Pinilla-Ibarz has received honoraria from AbbVie, Gilead Sciences, Janssen, Novartis, Pharmacyclics, Takeda, and Teva; has served in a consulting or advisory role for AbbVie, Janssen, Novartis, and Pharmacyclics; and has participated in a speakers bureau for AbbVie, Gilead Sciences, Pharmacyclics/Janssen, and Takeda.