Skip to main content
  • Advertise
    Want to Advertise with Us?
    Conquer welcomes advertising and sponsorship collaborations with reputable companies offering high-quality products and services to people affected by cancer.
  • Affiliated Brands
    Academy of Oncology Nurse & Patient Navigators
    The Academy of Oncology Nurse & Patient Navigators (AONN+) is the largest national specialty organization dedicated to improving patient care and quality of life by defining, enhancing, and promoting the role of oncology nurse and patient navigators. Our organization of over 8,900 members was founded in May 2009 to provide a network for all professionals involved and interested in patient navigation and survivorship care services to better manage the complexities of the cancer care treatment continuum for their patients. We view our organization as one consisting of “professional patient advocates” and, to that end, we support and serve our members.
    Journal of Oncology Navigation & Survivorship
    The Journal of Oncology Navigation & Survivorship (JONS) promotes reliance on evidence-based practices in navigating patients with cancer and their caregivers through diagnosis, treatment, and survivorship. JONS also seeks to strengthen the role of nurse and patient navigators in cancer care by serving as a platform for these professionals to disseminate original research findings, exchange best practices, and find support for their growing community.
    The Oncology Nurse-APN/PA
    The Oncology Nurse-APN/PA (TON) provides coverage of the wide spectrum of oncology-related events, trends, news, therapeutics, diagnostics, organizations, and legislation that directly affect hematology/oncology nurses and advanced practitioners involved in healthcare delivery and product utilization. The scope and coverage include a unique presentation of news and events that are shaping the care of patients with cancer.
  • Healthcare Providers
  • Contribute

Acalabrutinib versus Ibrutinib in Previously Treated CLL

Web Exclusives

For many patients with chronic lymphocytic leukemia (CLL), drugs called Bruton tyrosine kinase (BTK) inhibitors have become a mainstay of treatment since ibrutinib was first introduced in 2013.1 Despite advancing treatment for CLL, ibrutinib has been associated with potentially serious side effects, particularly those affecting the heart and cardiovascular system.1,2 A next-generation BTK inhibitor, acalabrutinib, has been developed to maximize the efficacy of this class of drugs, while limiting the side effects that were seen with ibrutinib.1

Recently, investigators reported the first results of the ELEVATE-RR clinical trial (NCT02477696; https://clinicaltrials.gov/ct2/show/NCT02477696), which compared ibrutinib versus acalabrutinib in previously treated patients with high-risk CLL.3,4 All patients in this trial had received ≥1 prior treatments for their CLL and had cancers with certain genetic mutations, called del(17p) or del(11q), which are expected to lead to a poorer clinical outcome.3-5

The ELEVATE-RR study was designed to compare how long patients survived without disease progression on each of the 2 treatments.3,4 Other outcomes that were assessed were the number of patients developing an abnormal heart rhythm (atrial fibrillation), having a serious infection, undergoing transformation from CLL to a more severe type of lymphoma (also called a Richter transformation), and the total amount of time that patients survived after beginning treatment.3,4

A total of 533 patients were included in the study, with 268 receiving acalabrutinib and 265 receiving ibrutinib.3 As is typical for patients with CLL, half of the study participants were aged >66 years.3 Most patients had received ≥2 prior therapies before enrolling in the study.3

Looking at efficacy, the investigators found no difference between acalabrutinib and ibrutinib. The median survival time without disease progression was 38.4 months for both groups.3 With regard to safety, patients receiving acalabrutinib had a lower likelihood of developing an abnormal heart rhythm than those receiving ibrutinib.3 No differences were seen between the 2 drugs with regard to the frequencies of developing a serious infection or having a Richter transformation to lymphoma.3 At the time the data were presented, investigators could not conclude whether there was any difference in overall survival between the 2 treatments.3

High blood pressure, joint pain, diarrhea, headache, and cough were side effects that affected >20% of patients in either treatment group.3 Of these, only headache and cough were more commonly seen in patients receiving acalabrutinib than in those receiving ibrutinib.3 Among other side effects that were infrequent, but of clinical interest, bleeding events and events affecting the heart were less frequent with acalabrutinib than with ibrutinib.3 Together, side effects caused fewer patients receiving acalabrutinib to quit the study compared with ibrutinib.3

Overall, the results of ELEVATE-RR indicate that for previously treated patients with high-risk CLL, acalabrutinib is just as effective as ibrutinib with fewer cardiovascular complications.3

References

  1. Isaac K, Mato AR. Acalabrutinib and its therapeutic potential in the treatment of chronic lymphocytic leukemia: a short review on emerging data. Cancer Manag Res. 2020;12:2079-2085.
  2. Salem JE, Manouchehri A, Bretagne M, et al. Cardiovascular toxicities associated with ibrutinib. J Am Coll Cardiol. 2019;74:1667-1678.
  3. Hillmen P, Byrd JC, Ghia P, et al. First results of a head-to-head trial of acalabrutinib versus ibrutinib in previously treated chronic lymphocytic leukemia. Presented at the 2021 European Hematology Association Meeting, June 9, 2021. Abstract S145.
  4. ClinicalTrials.gov. Study of acalabrutinib (ACP-196) versus ibrutinib in previously treated subjects with high-risk CLL. https://clinicaltrials.gov/ct2/show/NCT02477696. Accessed August 23, 2021.
  5. Hewamana S, Dearden C. Treatment options for high-risk chronic lymphocytic leukaemia. Ther Adv Hematol. 2011;2:147-159.

Recommended For You