Effect of Acalabrutinib on the T cell function

[ikahan]

My husband has been on Acalabrutinib for 3 months but he has developed a few days ago an ear infecion requiring antibiotics.

Does Acalabrutinib also increses the number and function of T cells the way ibrutinib does ?

pubmed.ncbi.nlm.nih.gov/287...

[lankisterguy Volunteer]

Hi ikahan,

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The article you referenced has an answer to your question, but it is written in moderately dense "MedSpeak"

Ibrutinib markedly increased CD4+ and CD8+ T cell numbers in CLL patients. This effect was more prominent in effector/effector memory subsets and was not observed with acalabrutinib . Ex vivo studies demonstrated that this may be due to diminished activation-induced cell death through ITK inhibition. PD-1 and CTLA-4 expression was significantly markedly reduced in T cells by both agents. While the number of Treg cells remained unchanged, the ratio of these to conventional CD4+ T cells was reduced with ibrutinib, but not acalabrutinib. Both agents reduced expression of the immunosuppressive molecules CD200 and BTLA as well as IL-10 production by CLL cells.

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And this was a small study with only 32 patients and some of the results are ex-vivo ( en.wikipedia.org/wiki/Ex_vi.... ), so the researchers will likely want to duplicate that work with more patients and more in-vivo study. CLL is known to have many tricks and turns when surrounded by the complex actions of the immune system and germinal centers ( lymph nodes, spleen, etc. ) en.wikipedia.org/wiki/Ex_vi....

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Len

[ikahan in reply to lankisterguy]

Yes this is a very small sudy. I was trying to find other studies but I couln't. Dr Byrd told me that both ibrutinib and acalabrutinib affect T cells but in different ways. Does this mean that acalabrutinib doesn't have the same ability to improve the immune system as ibrutinib does ?

[lankisterguy Volunteer in reply to ikahan]

I would expect that the CLL experts would say that they just don't have the data to answer your question. The immune system is incredibly complex, and the doctors still don't understand why some people can have low IGG and low Neuts and not get frequent infections, while others with much higher measured levels have infections.

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Len

[cajunjeff]

I remember reading that study a couple of years ago and the first thing I looked for was to see who sponsored it. Abbvie (ibrutinib) and Acerta (acalabrutinib) are competing for a multi billion dollar market.

I would think Abbvie was (is) very concerned about early data that acalabrutinib has less side effects of serious side effects like afib than does acalabrutinib. So it would very important for Abbvie to show that ibrutinib is a more effective drug than acalabrutinib.

I was not surprised to learn Abbvie was behind this study, or at least I think they were. It doesn’t mean the study is not valid, it just makes me wonder if this study was not designed in a way to make Ibrutinib look better than acalabrutinib.

I would like to see more studies sponsored by independent people comparing the two drugs in all regards as I am considering a switch from ibrutinib to acalabrutinib. Most everything else you read suggests these two drugs have similar efficacy.