Treatment Name: Acalabrutinib (Calquence®)
Acalabrutinib (Calquence®) is a Chemotherapy Regimen for Lymphoma, Mantle Cell
How does acalabrutinib work?
Acalabrutinib is an oral chemotherapy medication designed to cause cancerous B-lymphocytes to leave the bone marrow and lymph nodes and enter the bloodstream where they die more quickly.
Goals of therapy:
Acalabrutinib is taken to decrease the size of lymph nodes, decrease the size of an enlarged spleen, increase the number of good cells made in the bone marrow, and kill cancerous Mantle Cell Lymphoma (MCL) cells. Patients may benefit from increased appetite, disappearance of swollen lymph nodes, and improvement in normal blood cell counts. Acalabrutinib is not usually considered a cure for MCL and is used to control symptoms or prevent MCL from progressing (getting worse).
- Usual starting dose: 100 mg oral capsule by mouth twice daily, every day
Duration of therapy is indefinite, meaning that acalabrutinib should be taken as long as it is working and side effects are tolerable.
Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability.
In clinical studies, the most commonly reported side effects of acalabrutinib are shown here:
- Headache (38%)
- Bleeding, mostly in the form of bleeding (31%)
- Diarrhea (31%)
- Fatigue (27%)
- Muscle pain (21%)
- Cough (19%)
- Nausea (18%)
- Fever (15%)
- Anemia [low red blood cells] (12%)
- Neutropenia [low white blood cells] (10%)
- Thrombocytopenia [low platelets] (6%)
- Pneumonia (6%)
- Liver injury (4%)
- Urinary tract infection (4%)
- High blood pressure (2%)
- Tumor lysis syndrome (2%)
- Vomiting (2%)
- Shingles [an infectious rash caused by a virus] (2%)
- Eye infection (2%)
Acalabrutinib may increase your risk of developing atrial fibrillation, or afib. However, none of the 124 patients in the clinical study developed afib while taking acalabrutinib.
On average, 6% of patients discontinue treatment due to unacceptable side effects.
Note: Sepsis, a potentially life-threatening infection in the bloodstream, occurred in 2% of patients in the original clinical trial. Although sepsis is unlikely, it is important to recognize signs and symptoms of this infection in order to treat sepsis quickly if it occurs. Signs of a serious infection may include: fever, chills, shaking, word-finding difficulty or confusion, low blood pressure, flushing, and dizziness.
How often is monitoring needed?
Labs (blood tests) may be checked before treatment then periodically until stable. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), uric acid, phosphorous, lactate dehydrogenase (LDH), plus any others your doctor may order.
Tumor lysis syndrome may occur. Depending on baseline uric acid level and LDH, allopurinol may need to be taken for 7 to 28 days to help your kidneys eliminate uric acid.
How often is imaging needed?
Imaging may be checked before treatment and during treatment if there is concern for bleeding or an infection. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans. An electrocardiogram (ECG, or EKG) may be recommended if you feel that your heart is racing, which could be a sign of atrial fibrillation.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue acalabrutinib as planned, reduce the dose, delay the next dose until the side effect goes away, or switch to an alternative therapy.
- Ask your doctor if you are up to date on your pneumonia vaccines. Vaccination against pneumonia could prevent this life-threatening illness
- Bleeding risk may be increased. The reason for this is not known. Patients should report any signs of bleeding to their doctor immediately. If you are taking an antiplatelet medication to prevent a heart attack or an anticoagulant (blood thinner) for a blood clot, acalabrutinib may further increase your risk for bleeding. Talk with your doctor about the risks and benefits of taking this with other medications that increase the risk of bleeding
- As acalabrutinib may increase the risk of bleeding, it is important to tell the hematologist (cancer doctor) when you are having surgery or dental work and what type. They will then consider the risks versus benefits of temporarily holding acalabrutinib therapy for up to 7 days pre- and post-surgery or dental procedure. The length of time to hold doses will depend upon the type of surgery and the risk of bleeding
- Acalabrutinib may increase the risk of developing a bacterial, viral, or fungal infection. Be sure to tell your doctor if you develop any signs of an infection such as fever and chills after starting therapy. You may be given antibiotics, antifungals, and antiviral medications while taking acalabrutinib to help prevent an infection from occurring
- Acalabrutinib may increase your risk of developing secondary cancers with the most common being skin cancer. Avoid exposure to the sun by covering your skin with clothing and wearing sunscreen
- May interact with commonly used drugs for heartburn. Avoid taking any proton-pump inhibitors such as omeprazole (Prilosec®), esomeprazole (Nexium®), or lansoprazole (Prevacid®) while taking acalabrutinib. If you take famotidine (Pepcid®) or ranitidine (Zantac®), be sure to take your dose of acalabrutinib 2 hours before taking either of these medications. Antacids may be used as log as they are taken at least 2 hours before or 2 hours after taking a dose of acalabrutinib
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for mantle cell lymphoma. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Acalabrutinib (Calquence®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Acalabrutinib (Calquence®). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Acalabrutinib (Calquence®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with Acalabrutinib (Calquence®)