Acalabrutinib: A Selective Bruton Tyrosine Kinase Inhibitor for the Treatment of B-Cell Malignancies.

Acalabrutinib: A Selective Bruton Tyrosine Kinase Inhibitor for the Treatment of B-Cell Malignancies.
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DOI:
10.3389/fonc.2021.668162
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发表时间:
2021
影响因子:
4.7
通讯作者:
Wierda WG
Wierda WG
中科院分区:
医学3区
文献类型:
--
作者:
Abbas HA;Wierda WG

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布鲁顿酪氨酸激酶(BTK)是治疗B细胞恶性肿瘤的经过验证的靶点,BTK的口服抑制剂已成为这些疾病的标准治疗方法。Acalabrutinib是第二代、高选择性、强效、共价BTK抑制剂,在体外试验中表现出最小的脱靶活性,与第一类BTK抑制剂伊曲替尼相比,具有改善耐受性的潜力。Acalabrutinib分别于2017年和2019年在美国获批用于治疗复发性/难治性套细胞淋巴瘤(MCL)和慢性淋巴细胞白血病(CLL)。Acalabrutinib也正在进行其他B细胞恶性肿瘤的试验,包括单药治疗和联合治疗。在这篇综述中,我们讨论了临床试验的结果,评价acalabrutinib在慢性淋巴细胞白血病,MCL和瓦尔登斯特伦巨球蛋白血症患者的疗效和安全性。最近的3期数据显示,在复发性/难治性CLL患者中,与利妥昔单抗+艾代拉里斯或利妥昔单抗+苯达莫司汀相比,acalabrutinib改善了无进展生存期(PFS),在初治CLL患者中,与苯丁酸氮芥+obinutuzumab相比,acalabrutinib联合或不联合obinutuzumab改善了PFS。总体而言,acalabrutinib具有可耐受的安全性特征,大多数不良事件的严重程度为1/2级(最常见的是头痛和腹泻),并且由于不良事件而停药的发生率较低。
Bruton tyrosine kinase (BTK) is a validated target for treatment of B-cell malignancies, and oral inhibitors of BTK have emerged as a standard of care for these diseases. Acalabrutinib is a second generation, highly selective, potent, covalent BTK inhibitor that exhibits minimal off-target activity in in vitro assays, providing the potential to improve tolerability over the first-in-class BTK inhibitor, ibrutinib. Acalabrutinib was approved for the treatment of relapsed/refractory mantle cell lymphoma (MCL) and chronic lymphocytic leukemia (CLL) in the US in 2017 and 2019, respectively. Acalabrutinib is also undergoing trials for other B-cell malignancies, both as monotherapy and in combinations. In this review, we discuss results from clinical trials evaluating the efficacy and safety of acalabrutinib in patients with CLL, MCL, and Waldenstrom’s macroglobulinemia. Recent phase 3 data showed that acalabrutinib improved progression-free survival (PFS) compared with rituximab plus idelalisib or rituximab plus bendamustine in patients with relapsed/refractory CLL, and acalabrutinib with or without obinutuzumab improved PFS compared with chlorambucil plus obinutuzumab in patients with treatment-naïve CLL. Overall, acalabrutinib had a tolerable safety profile, with most adverse events being grade 1/2 severity (most commonly headache and diarrhea) and a low rate of discontinuation due to adverse events.
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