Calaquence reduced dosage

[gymbunny1]

I anyone on a reduced dosage of calaquence less than 100ml a day?

[AussieNeil Administrator]

I would hope that no one is on that low a dose of acalabrutinib, because AstraZeneca currently do not provide smaller than 100mg doses in either capsule or tablet form. Given you are recommended not to divide the current formulations of acalabrutinib into smaller doses, the only way you can safely, administration wise, achieve a lower dose, is by skipping alternate days. This is a very bad idea, because you risk the development of CLL refractory to BTKi treatment. That leaves you with the hope that your CLL isn't resistant to one of the non-covalent BTKi drugs, curently in clinical trials, or that switching to venetoclax will keep your CLL in check, after which you are reliant on finding a clinical trial to keep your CLL under control.

If you are able to do so, I would recommend switching to zanubrutinib/Brukinsa, which is available in smaller doses. It's not yet FDA approved for CLL, but has been recommended by the US NCCN for some time for CLL treatment, as it is FDA approved for Mantle Cell Lymphoma and FDA CLL approval is immininent. It also proved better than ibrutinib in a head to head trial and could be cheaper than both ibrutinib and acalabrutinib, as BeiGene chases market share.

There are slight differences in the side effect profile between acalabrutinib and zanubrutinib, so you should check with your specialist if they consider whether zanubrutinib is a better fit for you. Both are considerably better than ibrutinib in this regard.

Neil