Acalabrutinib — Penetration to the Spine

[DylanPxxx]

I have stage 4 NHL, CLL/SLL 11q. I received my diagnosis on 12/27/2019 and have not started treatment yet. I have enlarged liver, spleen, and lymph nodes. A spinal MRI showed a lesion on the spine and a lumbar puncture showed that cancer cells had entered the spinal fluid

My doctor is considering putting me on Ibrutinib because he ordered a lumbar puncture and there was evidence of cancer cells in the spinal fluid and Research shows that Ibrutinib has good penetration to the spine. I understand that the side effects of Acalabrutinib are more mild than Ibrutinib and am curious whether anyone knows if there has been any research showing whether Acalabrutinib penetrates into the spinal column.

[cajunjeff]

Dylan I do not know specifically the answer to your question. Intuitively I would think Ibrutinib and acalabrutinib are both molecule drugs that find their way into our bloodstream to inhibit btk on our Cll lymphocyte cells. So I would think acalabrutinib goes anywhere Ibrutinib goes and both go anywhere our blood flows.

There is evidence acalabrutinib has less side effects than Ibrutinib, but also some argument ibrutinib is more effective at restoring our immune systems. So I think the jury is still out on what drug overall is best. Given how heterogenous Cll is, it’s possible one drug works best for one person and the other for another person.

You are asking a good question. If I were starting a btk inhibitor today, I would certainly want to have a conversation with my doctor about which one to take.

[avzuclav]

I haven't seen anything acalabrutinib.

This is almost three years old:

"No data reporting central nervous system (CNS) penetration of acalabrutinib were available at the time of this publication. Meanwhile, ibrutinib has been shown to cross the blood-brain barrier and induce rapid, sustained responses in MCL patients with CNS relapse."

source: hoparx.org/drug-updates-fro...