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Purpose: The AMPLIFY trial recently established fixed-duration acalabrutinib, venetoclax, and obinutuzumab (AVO) as a new standard-of-care option for patients with previously untreated chronic lymphocytic leukemia (CLL) with wild-type ; however, due to the chemoimmunotherapy control arm, AMPLIFY excluded patients with high-risk aberration, for whom current standards of care are continuous Bruton tyrosine kinase inhibitor therapy or alternatively fixed-duration venetoclax-based doublets. AVO has not previously been evaluated in patients with CLL with aberration.

Methods: This investigator-sponsored, multicenter, phase II study enrolled patients with treatment-naïve CLL enriched for high-risk CLL, defined by aberration (ClinicalTrials.

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Article Synopsis
  • - Acalabrutinib, a more advanced treatment for chronic lymphocytic leukemia, has a better safety profile than older drugs but lacks clear guidelines on managing its side effects, prompting a study to establish best practices.
  • - A team of medical professionals across France found that hospital pharmacists should evaluate drug interactions before starting patients on acalabrutinib and advised against using it with certain medications that can increase risks of toxicity or reduce effectiveness.
  • - The study highlighted the need for monitoring blood pressure during treatment, outlined protocols for managing procedures, and suggested headache management strategies, demonstrating the importance of teamwork in improving patient care while using acalabrutinib.
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Acalabrutinib is a selective, second-generation Bruton tyrosine kinase inhibitor. In this open-label, parallel-group study, patients with relapsed/refractory (R/R) follicular lymphoma (FL) were randomised to either acalabrutinib monotherapy or acalabrutinib plus rituximab. An additional cohort of patients with treatment-naive (TN) FL received only the acalabrutinib-rituximab combination.

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Article Synopsis
  • Bruton's tyrosine kinase inhibitors (BTKis), including zanubrutinib, revolutionized the treatment of chronic lymphocytic leukemia (CLL) but have various side effects that affect patient tolerability.* -
  • The ALPINE trial demonstrated that zanubrutinib has superior clinical efficacy and progression-free survival compared to ibrutinib, with fewer cardiac toxicities but similar rates of neutropenia and hypertension.* -
  • Zanubrutinib is emerging as a new standard treatment for relapsed/refractory CLL, and ongoing research is exploring advanced therapies and drug combinations to further improve patient outcomes.*
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Current Approaches and Novel Agents in the Treatment of Chronic Lymphocytic Leukemia.

JCO Oncol Pract

October 2024

Willamette Valley Cancer Institute, Medical Director of Hematology Research: Sara Cannon, Eugene, OR.

Article Synopsis
  • - The treatment for chronic lymphocytic leukemia (CLL) is shifting from traditional chemoimmunotherapy (CIT) to more effective targeted therapies like covalent bruton tyrosine kinase inhibitors (cBTKis), which have been proven superior in clinical trials.
  • - Second-generation cBTKis, such as acalabrutinib and zanubrutinib, show better safety and effectiveness compared to the older drug ibrutinib, while the noncovalent BTK inhibitor, pirtobrutinib, has exhibited strong results after prior cBTKi failure.
  • - Innovative treatment combinations like venetoclax with obinutuzumab are highly effective, and new strategies such as BTK degrad
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