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首页> 外文期刊>Journal of the advanced practitioner in oncology >Hematologic Malignancies: 2021 ASCO Annual Meeting Highlights for the Advanced Practitioner: The Advanced Practitioner Perspective: First Results of a Head-to-Head Trial of Acalabrutinib vs. Ibrutinib in Previously Treated Chronic Lymphocytic Leukemia, By JADPRO Staff
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Hematologic Malignancies: 2021 ASCO Annual Meeting Highlights for the Advanced Practitioner: The Advanced Practitioner Perspective: First Results of a Head-to-Head Trial of Acalabrutinib vs. Ibrutinib in Previously Treated Chronic Lymphocytic Leukemia, By JADPRO Staff

机译：Hematologic Malignancies: 2021 ASCO Annual Meeting Highlights for the Advanced Practitioner: The Advanced Practitioner Perspective: First Results of a Head-to-Head Trial of Acalabrutinib vs. Ibrutinib in Previously Treated Chronic Lymphocytic Leukemia, By JADPRO Staff

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In the first head-to-head trial of Bruton tyrosine kinase inhibitors (BTKis) in chronic lymphocytic leukemia (CLL), acalabrutinib demonstrated noninferior progression-free survival (PFS) with less cardiotoxicity and fewer discontinuations due to adverse events compared with ibrutinib. The results of the open-label, randomized, noninferiority, phase III ELEVATE-RR trial shed light on the tolerability of these two BTKis in patients with previously treated CLL with high-risk features. The Advanced Practitioner Perspective: The approval of ibrutinib (Imbruvica) for the treatment of CLL marked the beginning of a paradigm shift in the treatment of CLL from traditional chemoimmunotherapy to novel targeted agents. The subsequent approval of the more selective second-generation BTK inhibitor, acalabrutinib (Calquence), based on the ELEVATE-TN and ASCEND trials, offered providers, including advanced practitioners, another option. The ELEVATE-RR trial represents an important and clinically relevant head-to-head comparison of ibrutinib vs. acalabrutinib in previously treated CLL; researchers found that acalabrutinib was in fact noninferior to ibrutinib in terms of PFS. Importantly, acalabrutinib demonstrated lower rates of all-grade atrial fibrillation (one of the study's secondary endpoints) as well as lower incidences of hyper-tension, arthralgias, and diarrhea. Although acalabrutinib was associated with higher incidences of headache and cough, fewer patients discontinued acalabrutinib due to side effects than those on ibrutinib. This is particularly important data for advanced practitioners to be aware of, as the best BTK inhibitor monotherapy is one that the patient can tolerate and will continue to take. Additionally, as advanced practitioners discuss choice of BTK inhibitors in patients with CLL, these data suggest that acalabrutinib may be the preferred choice for patients in whom risk for atrial fibrillation or worsening of preexisting hypertension is of significant concern. Other factors in the choice of BTK inhibitor for advanced practitioners to consider include the need for concomitant proton pump inhibitor (currently recommended against using in conjunction with acalabrutinib per the package insert), as well as the ability to more easily modify the dosing of ibrutinib compared to acalabrutinib for adverse events. While we can extrapolate that the efficacy will remain similar over time based on current data, longer-term studies are needed to confirm this prediction.

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