Next Steps for Acalabrutinib/Obinutuzumab in Treatment-Naive CLL

Jeff Sharman, MD, medical director of hematology research at US Oncology, discusses the clinical implications for oncologists based on data from the ELEVATE-TN trial (NCT02475681).

The study sought to assess treatment with acalabrutinib (Calquence) with or without obinutuzumab (Gazyva) in treatment-naive chronic lymphocytic leukemia (CLL). Here, Sharman also discusses potential avenues for future research in light of the 6-year follow-up results from the study.

Transcription:

0:10 | I think if a patient is going to be treated with a [Bruton’s tyrosine kinase (BTK)] inhibitor, particularly acalabrutinib, I think that the physician needs to have a thoughtful discussion with their patients about whether or not to add the additional anti-CD20 antibody. I do think that a growing number of key opinion leaders have started doing that more frequently. It still remains a little bit controversial, so we will see how this is received by the field. I hope it sparks some conversation.

0:40 | There are a handful of approaches you can take to treat a previously treated [patient with] CLL. That could be BTK monotherapy. It could be obinutuzumab with a BTK inhibitor. It could be obinutuzumab with venetoclax [Venclexta] or a BTK [inhibitor] with a BCL2 [inhibitor]. There are really 4 different strategies emerging. We want to know what is going to be the best one. We are currently conducting a randomized study in which all patients receive venetoclax and half receive obinutuzumab, half receive acalabrutinib, and I am hoping that that gives us some good insight into picking optimal first-line therapy, but there are patients where we are not going to want to choose venetoclax. For those patients, acalabrutinib in combination with obinutuzumab represents a good option.

REFERENCE:

Sharman JP, Egyed M, Jurczak W, et al. Acalabrutinib ± obinutuzumab Vs obinutuzumab + chlorambucil in treatment-naive chronic lymphocytic leukemia: 6-year follow-up of Elevate-TN. Blood. 2023; 142(Suppl 1): 636. doi:10.1182/blood-2023-174750