Lori Leslie, MD, Discusses the Real-World Differences Between Acalabrutinib and Ibrutinib

The medical oncologist from the John Theurer Cancer Center noted the importance of real-world data in determining potentially different toxicity profiles in these BTK-inhibitors.

Lori Leslie, MD, medical oncologist at the John Theurer Cancer Center, discussed the retrospective analysis of real-world patients being treated for chronic lymphocytic leukemia (CLL) with acalabrutinib (Calquence). 

So, there are an explosion of new agents entering our treatment options for CLL. And acalabrutinib is a BTK-inhibitor recently approved for use in frontline as well as relapsed/refractory CLL. The difference between the previously available BTK-inhibitor ibrutinib (Imbruvica) is potentially a different toxicity profile.

So, the goal of doing this real-world outcome study was to look at patients treated in the real world, not on clinical trial, who received acalabrutinib mostly for ibrutinib intolerance. And we found that the rate of discontinuation of ibrutinib, acalabrutinib, in patients who had not tolerated ibrutinib was low, suggesting that this is a well-tolerated alternative for patients who would benefit from BTK inhibition, but can’t tolerate ibrutinib for whichever side effect.

I think the importance of real-world data is becoming more and more apparent as we have these agents really rapidly entering our treatment options, because doing a specific study comparatively takes time to mature, especially in CLL which is a chronic disease. So by looking at large cohorts of patients treated, it helps us answer questions such as sequencing, adverse events, rates of infection, and it helps us figure out which patients benefit from a certain sequence versus another, and additionally cost of therapy, which is becoming more and more important as we get combination therapy or targeted therapy, whether as a monotherapy or a combination, moving forward.