Chronic Lymphocytic Leukemia: Acalabrutinib–Venetoclax Vs. Chemoimmunotherapy

Acalabrutinib and venetoclax are medications used together to treat chronic lymphocytic leukemia (CLL), a type of blood cancer. In patients who have not yet received treatment, this combination has shown to be more effective than traditional chemotherapy (1^✔ ✔Trusted Source
Fixed-Duration Acalabrutinib Combinations in Untreated Chronic Lymphocytic Leukemia

Go to source). This combination works by targeting cancerous B cells, which are a key part of the immune system. Acalabrutinib helps block a protein that allows these cells to survive and multiply, while venetoclax works by triggering the cancer cells to die. When used together, these drugs can slow down or even stop the growth of the leukemia cells.

Chemotherapy vs. Combination Therapy

In a study involving 867 patients, those who received the combination of acalabrutinib and venetoclax showed better results than those who were treated with chemotherapy. After about 3 years of follow-up, 76.5% of patients taking acalabrutinib and venetoclax alone were still free of disease progression, and 83.1% of those receiving the combination of acalabrutinib, venetoclax, and obinutuzumab (another drug added to the mix) had similar results. In comparison, only 66.5% of patients who were treated with chemotherapy stayed disease-free.

In addition to slowing disease progression, acalabrutinib and venetoclax also improved the chances of survival. After 3 years, 94.1% of patients on the combination treatment were still alive, compared to 85.9% of those who received chemotherapy.

Increased Risk of Infection with Neutropenia in Patients

However, the treatment does come with side effects. The most common are neutropenia, which is a condition where the body has too few white blood cells, increasing the risk of infection. About 32% of patients on the acalabrutinib–venetoclax regimen experienced neutropenia, compared to 43% to 46% in those who received the combination with obinutuzumab or chemotherapy. The study also reported that some patients died from COVID-19, with 10 deaths in the acalabrutinib–venetoclax group, 25 in the acalabrutinib–venetoclax–obinutuzumab group, and 21 in the chemotherapy group.

Overall, acalabrutinib and venetoclax offer a promising treatment option for patients with untreated CLL, providing better long-term control of the disease and improved survival rates compared to traditional chemotherapy. While side effects such as neutropenia are common, the benefits of this treatment make it an important choice for many patients.

Reference:

1. Fixed-Duration Acalabrutinib Combinations in Untreated Chronic Lymphocytic Leukemia - (https://www.nejm.org/doi/full/10.1056/NEJMoa2409804)

Source-Medindia