How effective and safe is acalabrutinib compared to other treatments for patients with mantle cell lymphoma?

This study compared the effectiveness and safety of acalabrutinib (Calquence) to other targeted therapies for patients with mantle cell lymphoma (MCL). The authors found that acalabrutinib was just as safe and more effective for these patients.

MCL is a type of non-Hodgkin's lymphoma treated in stages. Patients usually respond well to initial chemotherapy treatment. However, MCL returns (relapses) in some patients, while other patients stop responding to treatment (refractory). Treatment options are limited for these patients.

Targeted therapy with or without chemotherapy is one treatment option for patients with relapsed or refractory MCL. Acalabrutinib is a targeted therapy that blocks cancer cell growth and survival. Whether acalabrutinib is safer and more effective than other targeted therapies for patients with recurrent or non-responsive MCL is unclear. 

This study compared the safety and effectiveness of acalabrutinib (AC) versus other treatments for patients with recurrent or non-responsive MCL. The AC study had 124 patients. These patients were followed for an average of 26.3 months. This study was compared to 14 other studies that included 44 to 170 patients per treatment.

AC was compared to other targeted therapies alone. Compared to bortezomib (Velcade), AC increased treatment response by 50.6% and increased survival by 64%. Compared to ibrutinib (Imbruvica), AC increased the rate of complete responses (no detectable cancer) by 14.9% and had a 24% higher survival rate. 

Compared to lenalidomide (Revlimid), AC increased the rate of complete responses by 43.5% and chances of survival without cancer progression (cancer growing or spreading) by 35%. Compared to temsirolimus (Torisel), AC increased treatment response by 40.7% and survival by 68%.

AC was also compared to combinations of targeted therapies. Ibrutinib plus rituximab (Rituxan) increased treatment response by 10.6%, but AC increased complete responses by 8.3%. Bendamustine (Bendeka) plus rituximab increased treatment response by 9.8% compared to AC. Compared to these regimens, AC did not significantly improve survival.

Compared to lenalidomide plus rituximab, AC increased treatment response by 14.1% and chances of survival without cancer progression by 43%.

AC reduced the number of patients experiencing abnormal heartbeats and low platelets. AC was also associated with less diarrhea and fewer cases of low white blood cell counts. However, AC was associated with lower red blood cell counts and more infections.

The authors concluded that acalabrutinib was comparably safe but more effective than other targeted therapies for patients with recurrent or non-responsive MCL.

The manufacturer of acalabrutinib, AstraZeneca, funded this study. This study used data from retrospective trials that had different trial setups. More studies that directly compare acalabrutinib to other treatments are needed to confirm these results.

Talk to your doctor about which targeted therapy options that may be right for you.