Acalabrutinib is a cancer drug treatment for chronic lymphocytic leukaemia (CLL). It is also known as Calquence.
What is acalabrutinib?
Acalabrutinib is a type of targeted cancer drug. You pronounce acalabrutinib as a-kal-a-broo-ti-nib.
You have acalabrutinib if your CLL has not been treated before and:
- has a change (mutation) in the 17p chromosome or TP53 gene. Your doctor will check for these mutations before you can start this drug
- has no change (mutation) in the 17p chromosome or TP53 gene, and fludarabine plus cyclophosphamide and rituximab (FCR), or bendamustine plus rituximab (BR) is not suitable for you
How does acalabrutinib work?
Acalabrutinib is a type of targeted cancer drug called a bruton tyrosine kinase inhibitor.
Tyrosine kinase inhibitors (TKIs) block chemical messengers (enzymes) called tyrosine kinases. Tyrosine kinases help to send growth signals in cells, so blocking them stops the cell from growing and dividing.
How do you have acalabrutinib?
You take acalabrutinib as capsules.
When taking acalabrutinib capsules you swallow them whole with a full glass of water. You have the capsules with or without food. You should not open, crush or chew the capsules. You usually have them twice a day, about 12 hours apart.
Taking capsules
Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, not more or less.
Talk to your healthcare team before you stop taking or miss a dose of a cancer drug.
How often do you have acalabrutinib?
You will have treatment for as long as it is working and you can cope with any side effects.
Tests
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
What are the side effects of acalabrutinib?
How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having.
When to contact your team
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects aren’t getting any better
- your side effects are getting worse
Early treatment can help manage side effects better.
We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.
Common side effects
These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:
Increased risk of infection
Increased risk of getting an infection
is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
Second cancers
There is a risk of getting a second cancer. Your doctor will discuss the risk with you.
Second cancers might include a type of skin cancer called non-melanoma skin cancer. Your team will check you regularly for skin cancer and ask you to use sun protection when taking this drug.
Breathlessness and looking pale
You might be
breathless and look pale
due to a drop in red blood cells. This is called anaemia.Headaches
Let your doctor or nurse know if you have headaches. They can give you painkillers such as paracetamol to help.
Dizziness
This drug might make you feel dizzy. Don’t drive or operate machinery if you have this.
Bruising, bleeding gums or nose bleeds
This is due to a
drop in the number of platelets in your blood
. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).
Less commonly you might have bleeding in the
. Symptoms include vomiting blood, black stools, bleeding from the back passage (rectum), feeling lightheaded, fainting, difficulty breathing or having tummy pain.
Or you might have bleeding in the brain. Some symptoms include a headache, vomiting, drowsiness, confusion, seizures (fits) or going into a coma (becoming unconscious).
Diarrhoea or constipation
Tell your healthcare team if you have
diarrhoea or constipation
. They can give you medicine to help.Feeling or being sick
Feeling or being sick
is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, try eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.
Tummy (abdominal) pain
Tell your doctor or nurse if you have this. They can check for the cause of the pain and give you medicine to help.
Skin rash
A rash can also be itchy. Tell your doctor or nurse if you have a skin rash. They can prescribe medicine to stop the itching and soothe your skin.
Joint or muscle pain
You might feel some pain from your muscles and joints. Speak to your doctor or nurse about what painkillers you can take to help with this.
Tiredness and weakness
You might feel
very tired
and as though you lack energy.Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.
Occasional side effects
These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have:
- changes to your heart rhythm - your doctor might ask you to have tests to check your heart, such as an electrocardiogram (ECG)
Rare side effects
These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:
- a high number of white blood cells. You will have blood tests to check the number of white blood cells in your blood
- changes to the levels of chemicals in the blood due to breakdown of cancer cells (tumour lysis syndrome) – you have regular blood tests to check for this
Coping with side effects
We have more information about side effects and tips on how to cope with them.
What else do I need to know?
Other medicines, foods and drinks
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
Loss of fertility
It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Contraception and pregnancy
It is unknown whether treatment may or may not harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment. Let your team know straight away if you or your partner falls pregnant while having treatment.
Talk to your doctor or nurse about effective contraception you can use during treatment. Ask how long you should use it before starting treatment and after treatment has finished.
Breastfeeding
It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.
You should wait 2 days after your last dose before breastfeeding.
Treatment for other conditions
Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment. For example, if you need treatment for anything else, including teeth problems.
Immunisations
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.
You can have:
- other vaccines, but they might not give you as much protection as usual
- the flu vaccine (as an injection)
- the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment
Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your
recovers from treatment.
Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.
Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.
More information about this treatment
We haven't listed all the very rare side effects of this treatment. For further information see the electronic Medicines Compendium (eMC) website.
You can report any side effect you have that isn’t listed here to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.
