Leukemias, lymphomas, and other hematologic cancers:
Indications for CALQUENCE:
Mantle cell lymphoma (MCL) in adults who have received at least one prior therapy. Chronic lymphocytic leukemia (CLL). Small lymphocytic lymphoma (SLL).
Swallow whole with water. 100mg approx. every 12hrs until disease progression or unacceptable toxicity. In combination with obinutuzumab (CLL/SLL): initiate acalabrutinib at Cycle 1 of each 28-day cycle, then initiate obinutuzumab at Cycle 2 for a total of 6 cycles; give acalabrutinib prior to obinutuzumab if given on same day. Concomitant moderate CYP3A inhibitors: 100mg once daily. Concomitant strong CYP3A inducers: avoid; if needed, increase dose to 200mg every 12hrs. Dose modifications: see full labeling.
Risk of serious hemorrhagic events (monitor); consider the benefit/risk of withholding treatment for 3–7 days pre-and post-surgery. Monitor for infections; consider prophylaxis if at risk for opportunistic infections. Monitor for cytopenias; obtain CBCs regularly. Risk of second primary malignancies (eg, skin cancer or other carcinomas); advise patients to protect from sun exposure. Monitor for atrial fibrillation/flutter; manage appropriately. Severe hepatic impairment: not recommended. Advise females of reproductive potential to use effective contraception during and for ≥1 week after the last dose. Pregnancy: exclude status prior to initiation (potential risk of fetal harm and dystocia). Nursing mothers: not recommended (during and for ≥2 weeks after the last dose).
Bruton tyrosine kinase (BTK) inhibitor.
Avoid concomitant strong CYP3A inhibitors (eg, itraconazole); if short-term use (eg, anti-infectives for ≤7days), interrupt acalabrutinib therapy. Concomitant moderate CYP3A inhibitors, strong CYP3A inducers (eg, rifampin): see Adults. Increased risk of hemorrhage with concomitant antithrombotics; consider benefit/risk. Antagonized by gastric acid reducing agents (eg, PPI [avoid], H2-receptor antagonist, or antacid); if needed, consider ranitidine, famotidine, or calcium carbonate. Separate dosing by at least 2hrs with antacids. Take acalabrutinib 2hrs before H2-receptor antagonist use.
Anemia, neutropenia, thrombocytopenia, upper RTI, headache, diarrhea, musculoskeletal pain; hemorrhage, infections, second primary malignancy, atrial fibrillation/flutter.