Acalabrutinib

How it works

It selectively and covalently inhibits BTK, blocking B-cell receptor signalling required for the proliferation and survival of malignant B cells.

Prescribing in practice

• It increases the risk of bleeding, so use with caution alongside antiplatelet or anticoagulant therapy and consider withholding around surgery.
• Acid-reducing agents can lower absorption, so co-administration with proton pump inhibitors should be avoided and antacids separated in time.
• Atrial fibrillation, cytopenias and serious infections can occur and warrant monitoring.

Monitoring

Monitor full blood count periodically and remain alert for bleeding, new arrhythmia and signs of infection.

Counselling the patient

• Report unusual bruising, bleeding or an irregular or fast heartbeat.
• Avoid taking acid-suppressing stomach medicines unless agreed with your specialist team.
• Tell any surgeon or dentist that you take this medicine before procedures.

Evidence & guidelines

NICE recommends acalabrutinib as an option for untreated and previously treated chronic lymphocytic leukaemia.