Cardiovascular Medical Events in Patients with CLL, SLL Treated With Acalabrutinib or Zanubrutinib

A study presented at the 66th American Society of Hematology Annual Meeting & Exposition outlined the treatment-emergent cardiovascular medical events (CV-E) among patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) treated with acalabrutinib or zanubrutinib in the community oncology setting.

In the first-line setting, 1,476 patients were treated with either acalabrutinib (n=1,039) or zanubrutinib (n=437). A total of 199 patients reported a preexisting cardiac comorbidity during the year before initiation of Bruton tyrosine kinase inhibitor (BTKi) therapy, including 142 (13.7%) patients in the acalabrutinib group and 57 (13.0%) patients in the zanubrutinib group. The median follow-up from BTKi initiation was 13.1 months for the acalabrutinib group and 7.9 months for the zanubrutinib group.

Fewer patients in the acalabrutinib group experienced treatment-emergent CV-E after BTKi initiation compared with those in the zanubrutinib group (8.9% vs 12.2% during the nine months after BTKi initiation; 10.4% vs 15.3% during the 12 months after; and 11.0% vs 15.2% during the 15 months after, respectively). The rate of treatment-emergent hypertension (HTN) was also lower among patients receiving acalabrutinib with a follow-up of at least nine (5.2% vs 8.1%, respectively), 12 (5.7% vs 9.7%, respectively), or 15 months (6.9% vs 9.1%, respectively). However, the rate of treatment-emergent atrial fibrillation/flutter/arrythmia (afib) was comparable in both groups (3.1% vs 2.7% at nine months, 4.2% vs 4.2% at 12 months, and 4.0% vs 6.1% at 15 months, respectively).

Among the 386 patients treated with acalabrutinib (n=230) or zanubrutinib (n=156) in the second-line or later setting, 37 (16.1%) acalabrutinib-treated patients and 23 (14.7%) zanubrutinib-treated patients had a preexisting cardiac comorbidity during the year before BTKi initiation. The rates of treatment-emergent CV-E, HTN, and afib were all lower among patients treated with acalabrutinib versus zanubrutinib in the second-line or later setting.

Specifically, the rate of treatment-emergent CV-E during the nine, 12, or 15 months after BTKi initiation was 14.9%, 14.5%, and 12.3% for the acalabrutinib group, compared with 33.3%, 30.8%, and 33.3% for the zanubrutinib group. The rate of treatment-emergent HTN among patients with at least 9, 12, or 15 months of follow-up was 7.9%, 7.9%, and 8.8% for acalabrutinib versus 21.6%, 19.2%, and 16.7% for zanubrutinib. Finally, the rate of treatment-emergent afib among patients with at least 9, 12, or 15 months of follow-up was 6.9%, 6.6%, and 5.3% for acalabrutinib and 13.7%, 11.5%, and 16.7% for zanubrutinib.

Reference

Hou JZ, Choksi R, Vasudevan A, et al. Treatment-emergent cardiovascular events among patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) treated with Bruton’s tyrosine kinase inhibitors (BTKi). Abstract #3253. Presented at the 66th American Society of Hematology Annual Meeting & Exposition; December 7-10, 2024; San Diego, California.