Acalabrutinib Combinations as Initial Therapy for Chronic Lymphocytic Leukemia

Frontline treatment of chronic lymphocytic leukemia (CLL) with a Bruton tyrosine kinase inhibitor (BTKi) has largely replaced chemoimmunotherapy, with BTKi therapy typically continued until disease progression or unacceptable toxicity occurs. Researchers report a multinational, industry-sponsored, phase 3 trial comparing fixed-duration acalabrutinib combinations against chemoimmunotherapy in 867 previously untreated patients with CLL. Patients were randomized to 28-day cycles of the BTKi acalabrutinib (A; twice daily, cycles 1–14) plus the B-cell lymphoma-2 inhibitor venetoclax (V; cycles 2–14), or the same regimen plus the anti-CD20 antibody obinutuzumab (O; cycles 2–7), or investigator's choice of 6 cycles of bendamustine-rituximab or flu…