FDA Approves Acalabrutinib for CLL and SLL

This review was conducted under Project Orbis (https://www.fda.gov/about-fda/oncology-center-excellence/project-orbis), an initiative of the FDA Oncology Center of Excellence. Project Orbis provides a framework for concurrent submission and review of oncology drugs among international partners. The FDA, the Australian Therapeutic Goods Administration, and Health Canada collaborated on this review.

Approval was based on two randomized, actively controlled trials in patients with CLL: ELEVATE-TN (NCT02475681) and ASCEND (NCT02970318). Efficacy in both trials was based on progression-free survival (PFS) as assessed by independent review.

ELEVATE-TN randomized 535 patients with previously untreated CLL to one of three arms: acalabrutinib monotherapy, acalabrutinib plus obinutuzumab, or obinutuzumab plus chlorambucil. With a median follow-up of 28.3 months, PFS was significantly improved in both acalabrutinib arms. Compared to the obinutuzumab plus chlorambucil arm, the hazard ratio (HR) for PFS was 0.10 (95% CI: 0.06, 0.17; p < 0.0001) with acalabrutinib plus obinutuzumab and 0.20 (95% CI: 0.13, 0.30; p < 0.0001) with single agent acalabrutinib.

ASCEND randomized 310 patients with relapsed or refractory CLL after at least one prior systemic therapy to receive either acalabrutinib or investigator’s choice (either idelalisib plus a rituximab product, or bendamustine plus a rituximab product). With a median follow-up of 16.1 months, PFS was significantly longer in the acalabrutinib arm compared to the investigator’s choice arm (HR 0.31; 95% CI, 0.20, 0.49; p < 0.0001).

In both trials, median PFS had not been reached in the acalabrutinib arms. In addition, median overall survival had not been reached in any arm for either trial, with fewer than 15% of patients experiencing an event.

The most common adverse reactions (≥ 30%) of any grade in patients with CLL were anemia, neutropenia, thrombocytopenia, headache, upper respiratory tract infection, and diarrhea.

The recommended dose is 100 mg orally every 12 hours; swallow whole with water and with or without food.

View full prescribing information for acalabrutinib (https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/210259s006s007lbl.pdf).

This review used the Real-Time Oncology Review (https://www.fda.gov/about-fda/oncology-center-excellence/real-time-oncology-review-pilot-program) (RTOR) and Assessment Aid (https://www.fda.gov/about-fda/oncology-center-excellence/assessment-aid-pilot-project) pilot programs, which streamlined data submission prior to the filing of the entire clinical applications, and facilitated discussions among the regulatory agencies. These applications were approved four months prior to the FDA goal date. The FDA granted these applications Priority Review and Breakthrough Therapy designation. A description of FDA expedited programs is in the Guidance for Industry: Expedited Programs for Serious Conditions-Drugs and Biologics (https://www.fda.gov/regulatory-information/search-fda-guidance-documents/expedited-programs-serious-conditions-drugs-and-biologics).

Healthcare professionals should report all serious adverse events suspected to be associated with the use of any medicine and device to FDA’s MedWatch Reporting System (https://www.accessdata.fda.gov/scripts/medwatch/index.cfm) or by calling 1-800-FDA-1088.

For assistance with single-patient INDs for investigational oncology products, healthcare professionals may contact OCE’s Project Facilitate (https://www.fda.gov/about-fda/oncology-center-excellence/project-facilitate) at 240-402-0004 or email OncProjectFacilitate@fda.hhs.gov (mailto:OncProjectFacilitate@fda.hhs.gov).

In collaboration with the FDA and as a service to our members, ONS provides updates on recent FDA approvals and other important FDA actions (e.g., updated safety information, new prescribing information) pertaining to therapies for patients with cancer. This allows the agency to inform oncologists and professionals in oncology-related fields in a timely manner. Included in the FDA updates is a link to the product label or to other sites for additional relevant clinical information. In supplying this information, ONS does not endorse any product or therapy and does not take any position on the safety or efficacy of the product or therapy described.