Acalabrutinib [Specialist drug]

How it works

It covalently and selectively inhibits Bruton tyrosine kinase, blocking B-cell receptor signalling and impairing malignant B-lymphocyte proliferation and survival.

Prescribing in practice

• It increases the risk of bleeding, so assess bleeding risk and consider interrupting treatment around surgery and review concurrent anticoagulants and antiplatelets.
• Atrial fibrillation, cytopenias and serious infections can occur, and second primary malignancies have been reported.
• Avoid co-administration with acid-reducing agents such as proton pump inhibitors and with strong CYP3A inhibitors or inducers as set out in the SPC.

Monitoring

Monitor full blood count, for new bleeding, infection and for new or worsening cardiac arrhythmia during treatment.

Counselling the patient

• Report unusual bruising or bleeding, and tell any clinician you take this before surgery or dental work.
• Report palpitations, fever or signs of infection promptly.
• Avoid taking indigestion remedies close to your dose and check before adding any new medicines.

Evidence & guidelines

NICE technology appraisals support acalabrutinib for chronic lymphocytic leukaemia in defined patient populations.