Acalabrutinib Shows Promise in Marginal Zone Lymphoma

TON - October 2022 Vol 15, No 5

Treatment with acalabrutinib (Calquence) elicited a complete or partial response in ≥50% of patients with relapsed or refractory marginal zone lymphoma (MZL), according to interim results of a study presented by L. Elizabeth Budde, MD, PhD, Associate Professor, Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, at the 2022 American Society of Clinical Oncology Annual Meeting.

“MZL is a rare, indolent B-cell lymphoma that is considered incurable after recurrence. Similar to many B-cell malignancies, the pathway involved in the pathogenesis of MZL can be moderated through inhibition of Bruton tyrosine kinase [BTK]. Acalabrutinib is a next-generation BTK inhibitor approved for other malignancies. It has previously demonstrated activity in MZL,” Dr Budde told attendees.

Study Details

In the open-label, phase 2 trial, 42 patients with histologically confirmed relapsed or refractory MZL who had received ≥1 previous systemic therapies were administered acalabrutinib 100 mg orally twice daily until disease progression or unacceptable toxicity.

The primary efficacy outcome of the trial was overall response rate (ORR). Secondary outcomes included duration of response (DOR), progression-free survival (PFS), overall survival (OS), and safety.

The study population was 60.5% male, and the median age was 69 years (range, 42-84 years). The majority of

the patients (53.5%) had an Eastern Cooperative Oncology Group performance status of 0. MZL subtypes were extra nodal (43%), nodal (31%), and splenic (26%).

At data cutoff (October 15, 2021), median follow-up duration was 10.7 months (range, 0.4-42.8 months). Sixteen (38%) patients discontinued treatment with acalabrutinib, most commonly due to disease progression (26%). Among 35 patients evaluable for response, the investigator-assessed ORR was 54%, with 6 (16%) complete responses and 14 (38%) partial responses. The ORRs according to subtype were extra nodal (65%), nodal (44%), and splenic (45%). Seventeen (46%) patients had stable disease.

Median time to first response was 3 months, and median DOR was 19.3 months. Median PFS was 27.4 months, with a 12-month rate of PFS of 66%. The median OS was not reached.

There were 4 deaths reported (3 due to disease progression and 1 due to an adverse event [AE]).

Treatment with acalabrutinib monotherapy was generally well-tolerated, and most of the AEs were grades 1 or 2. Sixteen (38%) patients had grade ≥3 AEs, most commonly anemia, dyspnea, and neutrophil count decrease (3 each); and fatigue, thrombocytopenia, and neutropenia (2 each). AEs resulting in treatment discontinuation occurred in 2 patients (grade 3 hypotension and grade 1 myalgia).

Among AEs of clinical interest, hypertension was reported in 2 patients (both cases were grade 2). There were no cases of atrial fibrillation/flutter or major hemorrhage.

“These early results indicate that acalabrutinib is efficacious and well-tolerated in patients with relapsed or refractory MZL. The adverse event profile is consistent with the known safety profile of acalabrutinib in other hematologic malignancies,” stated Dr Budde.

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