SOHO 2021: How Does Acalabrutinib Measure Up Against Ibrutinib in CLL?
Posted: Tuesday, September 28, 2021
The increased selectivity of the Bruton’s tyrosine kinase (BTK) inhibitor acalabrutinib may improve tolerability compared with the older BTK inhibitor ibrutinib in previously treated patients with chronic lymphocytic leukemia (CLL), according to the first results of a head-to-head trial comparing the two BTK inhibitors. These findings, which were presented during the 2021 Society of Hematologic Oncology (SOHO) Annual Meeting (CLL-115), by John C. Byrd, MD, of The Ohio State University Comprehensive Cancer Center, Columbus, and colleagues, also demonstrated noninferior progression-free survival with acalabrutinib in this select patient population.
“Acalabrutinib demonstrated…less cardiotoxicity and fewer discontinuations due to adverse events versus ibrutinib,” the investigators noted.
In total, 533 patients (median age, 66 years) were randomly assigned to receive oral acalabrutinib at 100 mg twice daily or ibrutinib at 420 mg once daily until disease progression or unacceptable toxicity. At a median follow-up of 40.9 months, acalabrutinib was noninferior to ibrutinib, with a median progression-free survival of 38.4 months in both arms.
Regarding adverse events, acalabrutinib was reported to be statistically superior to ibrutinib in terms of the incidence of all-grade atrial fibrillation (9.4% vs. 16.0%). In addition, acalabrutinib was associated with a lower incidence of hypertension (9.4% vs. 23.2%), arthralgia (15.9% vs. 22.8%), and diarrhea (34.6% vs. 46.0%) compared with ibrutinib. In contrast, patients in the acalabrutinib cohort had a higher incidence of headache and cough. Adverse events led to treatment discontinuation in 14.7% of the patients in the acalabrutinib group versus 21.3% of the patients in the ibrutinib group.
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