Acalabrutinib (CALQUENCE)

Chronic lymphocytic leukemia

Mantle cell lymphoma

Chronic lymphocytic leukemia

• Dose – Oral: 100 mg twice daily continuously until disease progression or unacceptable toxicity

Mantle cell lymphoma

• Dose – Oral: 100 mg twice daily continuously until disease progression or unacceptable toxicity

Available as: acalabrutinib 100 mg hard gelatin capsules. Capsules contain propylene glycol. Capsules should NOT be opened. Acalabrutinib tablets also available, supplied as acalabrutinib maleate 100mg tablets. Tablets should NOT be crushed or broken. Store at room temperature.

Bruton’s Tyrosine Kinase Inhibitor

Take with or without food. Take doses approximately 12 hours apart.

If a dose is missed, patients should be instructed to take it as soon as they can if it is within 3 hours of the missed dose. If it is over 3 hours since the missed dose, patients should skip the missed dose and resume with the next scheduled dose.

Common: Anemia, Lymphocytosis, Neutropenia, Thrombocytopenia, Diarrhea, Fatigue, Infection, ALT increase / AST increase, Nausea, Musculoskeletal pain, Headache, Bruising, Hemorrhage/hematoma.

Less Common: Atrial fibrillation/flutter, Herpesvirus infection, Second primary malignancies.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Baseline before treatment: CBC & differential, platelets, creatinine, bilirubin, ALT, HBsAg, HBcoreAb.

During treatment: CBC & differential, platelets, bilirubin, ALT.

If clinically indicated: Baseline ECG should be arranged if patient has cardiac risk factors such as hypertension, diabetes mellitus, pre-existing arrythmias or history of heart failure.

• Avoid use of acalabrutinib CAPSULES with proton pump inhibitors due to ↓ acalabrutinib absorption. Take acalabrutinib capsules 2 hours before taking a H2-receptor antagonist. Separate dosing by at least 2 hours with antacids.
• Acalabrutinib TABLETS can be co-administered with gastric acid reducing agents.
• Avoid grapefruit, grapefruit juice, Seville oranges, or Seville orange juice.
• This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
• Current drug interaction databases should be consulted for more information.

• Avoid in pregnancy and lactation.
• Avoid taking acalabrutinib capsules with orange juice and other acidic beverages; administration with water is preferred; (NOTE: no action required for acalabrutinib maleate tablets).
• Atrial fibrillation/flutter risk may be increased. Monitor for signs/symptoms of atrial fibrillation and atrial flutter.
• Second primary malignancies, including skin and other solid tumours, have been reported. The most frequent second primary malignancy was skin cancer, reported in 6% of patients.  Patients should be counselled on appropriate suncare to help reduce their risk.
• Serious hemorrhagic events, including fatal events, have been reported in patients with hematologic malignancies. Consider the risks and benefits of antithrombotic agents when co-administered with Acalabrutinib.  Monitor all patients for signs of bleeding.

BC Cancer. BC Cancer Drug Manual.  Acalabrutinib.  Vancouver, British Columbia: BC Cancer Agency. Available at: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Acalabrutinib_monograph.pdf. Updated January  1, 2024. Accessed January 22, 2024.

Lexicomp. Acalabrutinib Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at:https://online-lexi-com.qe2a-proxy.mun.ca/lco/action/doc/retrieve/docid/patch_f/6564511?cesid=7q8BOFzrdTW&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3DAcalabrutinib%26t%3Dname%26acs%3Dfalse%26acq%3DAcalabrutinib . Updated January 24, 2024. Accessed January 31, 2024.

Cancer Care Ontario. Acalabrutinib Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/63766. Updated September  2023. Accessed January 22, 2024AstraZeneca Canada Inc. CALQUENCE® Tablets Product Monograph. Mississauga, Ontario. Updated February 24, 2023.