Acalabrutinib Appears Promising as Monotherapy in CLL

Tanya Siddiqi, MD, a hematologist/oncologist at City of Hope, discusses how she sees acalabrutinib (Calquence) fitting into the treatment landscape for patients with chronic lymphocytic leukemia (CLL) following the results from the phase III ASCEND trial. In August 2019, the FDA granted a breakthrough therapy designation to acalabrutinib as monotherapy for the treatment of patients with CLL based on data from the phase III ASCEND and ELEVATE-TN trials.

According to Siddiqi, acalabrutinib would be an excellent second option for patients with CLL if it is approved by the FDA. Acalabrutinib appears to have a slightly better toxicity profile than ibrutinib (Imbruvica). In the ASCEND trial, acalabrutinib demonstrated fewer hypertension events, fewer bleeding events, and a little bit less atrial fibrillation, Siddiqi says.

ASCEND was the first trial to report data comparing 2 novel agents in this setting, though many trials are ongoing, Siddiqi says. The trial clearly showed acalabrutinib looked better than idelalisib (Zydelig) and bendamustine/rituximab (Rituxan) combinations in terms of progression-free survival. This is also the first time a trial has shown that acalabrutinib is better than idelalisib, which is great to know, Siddiqi notes.