Invited study discussant Jacqueline C. Barrientos, MD, MS, of Northwell Health Cancer Institute, Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, commented: “The BTK [Bruton’s tyrosine kinase] inhibitors ibrutinib and acalabrutinib, along with the BCL2 inhibitor venetoclax, are approved for chronic lymphocytic leukemia [CLL], given demonstrated superiority over chemoimmunotherapy. All these drugs have outstanding efficacy but also have risks. Over time, the toxicity profile decreases drug tolerability, leading to discontinuations and progressive disease.”
Dr. Barrientos continued: “ELEVATE-RR was the first study to compare two BTK inhibitors directly in relapsed or refractory CLL. It was conducted in 124 centers in 15 countries.”
Jacqueline C. Barrientos, MD, MS
Quality of Life
Dr. Barrientos agreed that the cardiac toxicity profile of acalabrutinib was an advantage over ibrutinib. “By reducing and/or delaying the onset of these cardiac toxicities, acalabrutinib may improve the long-term adherence to BTK inhibitor therapy.”
“Based on the data presented, acalabrutinib use will have an impact on patients’ quality of life. Although this was a high-risk cohort of patients with relapsed disease, these data confirm prior reports of lower toxicity with acalabrutinib [compared with ibrutinib] and would likely be extrapolated to patients who are not at risk and into earlier lines of therapy,” Dr. Barrientos stated.
DISCLOSURE: Dr. Barrientos has received honoraria from Janssen; has served as a consultant or advisor to AbbVie, AstraZeneca, BeiGene, Genentech, Gilead Sciences, Innate Pharma, and Pharmacyclics; and has received institutional research funding from AstraZeneca, Oncternal Therapeutics, and Pharmacyclics.
Acalabrutinib was equally efficacious with less toxicity when compared directly with ibrutinib in patients with previously treated relapsed or refractory chronic lymphocytic leukemia (CLL), according to the results of an open-label, randomized, noninferiority phase III trial presented at the 2021