DOI: 10.1111/bjh.19951 ISSN: 0007-1048

Acalabrutinib in combination with rituximab and lenalidomide in patients with relapsed or refractory follicular lymphoma: Results of the phase 1b open‐label study (ACELY‐003)

Paolo Strati, Richy Agajanian, Izidore S. Lossos, Morton Coleman, Robert Kridel, Andrew Wood, Robin Lesley, Chuan‐Chuan Wun, Deborah M. Stephens

Summary

Patients with relapsed/refractory (R/R) follicular lymphoma (FL) have limited effective treatment options. Bruton tyrosine kinase inhibitors (BTKis) increase the anti‐tumoural phenotype of tumour‐associated macrophages, providing rationale to combine them with rituximab and lenalidomide (R2). Acalabrutinib, a second‐generation BTKi, has potential to improve R2 efficacy without increasing T‐cell–mediated toxicity due to its lack of interleukin‐2–inducible T‐cell kinase inhibition. Here, we report safety and efficacy from a phase 1b dose‐finding study (NCT02180711) evaluating acalabrutinib plus R2 in patients with R/R FL. Overall, 29 patients received acalabrutinib plus R2 (lenalidomide 15 mg, n = 8; lenalidomide 20 mg, n = 21). At a median acalabrutinib exposure of 21 months, the most common grade ≥3 treatment‐emergent adverse event (TEAE) was neutropenia (37.9%). The incidence of grade ≥3 serious TEAEs was 37.5% and 52.4% in the lenalidomide 15‐mg and 20‐mg cohorts, respectively; overall, the most common were COVID‐19 pneumonia, COVID‐19 infection and pneumonia. Earlier treatment withholdings/reductions were observed in the 20‐mg cohort. With a median follow‐up of 34.1 months, the overall response rate was 75.9%. The complete response rate was 25.0% and 42.9% in the lenalidomide 15‐ and 20‐mg cohorts, respectively. Due to acceptable toxicity and preliminary efficacy, the lenalidomide 20‐mg dose was selected for further investigation.

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