Reduced DOSE of Acalabrutinib/Calquence

[Brucex100]

HAs anyone been offered a reduced dose of Calquence - other than the 100mg that it comes as standard?

thanks

[AussieNeil Partner Administrator]

We have a few members on a reduced acalabrutinib dose. Because the 100mg capsules and tablets are the only dose currently available, reduced dosing is done by dropping to one, rather than the usual two capsules per day. That means that there is theoretically a higher risk of disease progression due to resistance developing when blood serum level drops low, so I would suggest that switching to a lower dose would best be done when the CLL tumour burden has been greatly reduced.

Neil

[Brucex100 in reply to AussieNeil]

thanks Neil

[onu1tadi2 in reply to AussieNeil]

I am on the 100 mg, one pill a day calquence dose. Been on it almost 2 years. My blood counts are normal. Have been in remission for about 5 years. Previously on ibrutinib. But I cannot get the flow cytometry test for MRD info in Ontario. It would give me some idea of probababilites as result of lower dose. It could indicate need for full dose of whether it is safe to take a holiday. I feel like i am in suspension, going into this blindly. I reduced dose to avoid arrythmia which ibrutinib at 3/4 dose still gave me. Now i only get Afib from extreme stress or too much salt. Any thoughts would be greatly appreciated.

[AussieNeil Partner Administrator in reply to onu1tadi2]

I haven't seen any studies yet that have identified the markers associated with achieving uMRD and or the ability to take a long holiday from Calquence. Do you happen to know any of your markers, from your immunophenotype flow cytometry or FISH or IGHV mutation or TP53 mutation or B2M tests at diagnosis or more recently? I appreciate it's difficult to get these done in Canada.

How have your last few lymphocyte tests been?

Neil

[onu1tadi2 in reply to AussieNeil]

Hi AussieNeil,

My lymphocytes have been normal since starting Ibrut and then Calquence for several years including test done in August '22. My FISH: positive 13q deletion; negative 11q deletion; negative for trisomy 12; negative for 17p deletion. I think this info was from bone marrow aspirate 2017. I am due for a CT scan next month, which I am not happy about since I have had 3 or 4 scans in past few years. But have swollen adenoids (other glands are OK). If this tells you something, I sure would be grateful for any feedback -- my onc/haemotologist barely talks. Thank you so much for responding to me.

[AussieNeil Partner Administrator in reply to onu1tadi2]

You have a the best possible markers for the older chemoimmunotherapy treatments, which also usually correspond to slow progression. So I suspect that you are a good candidate to have a treatment holiday. I note from bio, that you stayed in remission for the 7 months from when you stopped taking ibrutinib to when you restarted on Calquence.

Why all the scans? Do you have the SLL presentation of CLL/SLL, is it because your specialist doesn't see many CLL patients or was there a concern with a previous CT scan report? You don't mention being in any clinical trials. As much as we'd prefer not to have CT scans, they are the best means to measure the size of our nodes, spleen and other organs.

If you get a good result from your CT scan, you have some good reasons to ask if you can try a treatment holiday. Just make certain that you can again access to Calquence should you need it.

Neil

[onu1tadi2 in reply to AussieNeil]

Thanks. Yes, Calquence allows one holiday from the drug in order to still be eligible to resume taking it. My Onc seems to feel CT scans are harmless. She told me she had a pregnant woman have a scan with no negative consequences. (She seems oblivious to the fact that the effects are accumulative.) She said that it is time for a scan as that is the protocol or something. Not sure if that is what Calquence demands? (I will call Calquence and ask). Also she said this after discovering hands-on that I had swollen adenoids. (and seemed to imply a scan might help discover reason for my cough, which really has lasted for years, but got worse in past 2 years.) I did tell her I would like some idea of MRD, not sure if that influences things. Really, maybe I should try to reach her before mid Nov. when scan is scheduled to find out why I need it. (I had some scans just 2 years ago before getting minor surgery for a parathyroid gland removal.) Will let you know if I get any answers. This forum is, by the way, a godsend to so many of us.