Chronic Lymphocytic Leukemia Coverage from Every Angle

Comparing Front-Line Treatments in CLL: Focus on Acalabrutinib

By: Joseph Fanelli
Posted: Monday, October 26, 2020

According to findings presented in Clinical Therapeutics, patients with chronic lymphocytic leukemia (CLL) experienced favorable progression-free survival and overall survival outcomes when treated with Bruton’s tyrosine kinase inhibitor acalabrutinib compared with other front-line therapies. Acalabrutinib provided these benefits when used as monotherapy as well as in combination with the monoclonal antibody obinutuzumab, concluded Veronique Leblond, MD, of Sorbonne University, France, and colleagues.

“Although our network meta-analyses provide useful insights into the relative efficacy of acalabrutinib compared with other front-line treatments of CLL, the results cannot be considered confirmatory, and head-to-head randomized trials are needed, especially to compare the efficacy of acalabrutinib versus other targeted agents,” the authors cautioned.

The authors evaluated the efficacy of acalabrutinib by performing a network meta-analysis of the ELEVATE-TN study and eight randomized controlled trials that used front-line CLL therapies. The authors constructed two evidence networks: Network A, which consisted of randomized controlled trials that met inclusion criteria, and Network B, which used seven randomized controlled trials and a published cross-trial comparison of ibrutinib from RESONATE-2.

In both networks, acalabrutinib plus obinutuzumab, as well as acalabrutinib monotherapy, demonstrated significant improvements in progression-free survival compared with the other therapies. Of note, the authors found a significant difference in progression-free survival for patients treated with acalabrutinib monotherapy compared with venetoclax plus obinutuzumab in Network B but not in Network A.

Overall survival hazard ratios all favored acalabrutinib, although not significantly in most treatments. Acalabrutinib plus obinutuzumab ranked highest in improvements in progression-free and overall survival, followed by treatment with acalabrutinib monotherapy in Networks A and B, respectively.

Disclosure: For full disclosures of the study authors, visit

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