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Acalabrutinib- is a second-generation Bruton tyrosine kinase (BTK) inhibitor intended to take on the targeted therapy of B cells malignancies. BTK is critical in the signaling cascade which regulates the survival of the B-lymphocytes, their proliferation and migration. 

BTK is over exaggerated in several types of blood cancer including the chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), and mantle cell lymphoma (MCL) and thus enables the cancerous B-cells to proliferate indefinitely.

Acalabrutinib (Acabrunat) can inhibit this process by irreversibly binding to the BTK enzyme and halting the errant signalling, slowing the disease and increasing the toxicity of cancerous cells.

 Relative to previous BTK inhibitors such as ibrutinib, acalabrutinib was optimized relative to a greater selectivity to reduce off-target effects on non-relevant kinases. This is reflected in the possible decreased side effects, the side effects pertaining to bleeding, cardiovascular effects and skin effects.

In 2017, the medicine was approved by FDA to treat mantle cell lymphoma with subsequent approval in 2018 to treat chronic lymphocytic leukemia and small lymphocytic lymphoma. It is now believed to be among the most promising therapies in B-cell malignancy treatment in the contemporary era, especially among patient populations suitable not to undergo standard chemotherapy or patients who may have relapsed to other treatment regimens.

Acalabrutinib Usage/Dosage

Acalabrutinib for adults is prescribed as 100 mg, orally, twice a day (12 hours). The dosages are typically scheduled to be taken at approximately the same time everyday, in order to ensure a continuous level of the medication in the bloodstream.

Administration: The tablets or capsules are to be taken in with water with the whole piece. They must not be opened, broken or chewed.

Food: It can be consumed with and without food. Nevertheless, patients are not advised to take anything related to grapefruits or Seville oranges since they inhibit the working of drugs.

Length of therapy: Treatment can be continued until there is any progression of disease or intolerable toxicity. The duration of treatment is not established and some patients stay in treatment for years.

Missed dose: Take the dose as soon as possible, and look at the regular schedule; otherwise, skip the dose and continue. It is not desirable to increase the subsequent dose by a factor or two.

Concomitant medicine: Proton pump inhibitors (PPIs) are not recommended because they decrease absorption. In the event that acid suppression is necessary, timing modifications can be maintained using H 2 antagonists or antacids.

Special considerations

Kidney failure: There is typically no significant change needed in mild to moderate renal dysfunction but surveillance is suggested.

Hepatic dysfunction: Patients with hepatic dysfunction can require dose adjustments and special care.

Older patients: Minor differences in the efficacy are not noted but frailer patients should be monitored more closely.

Acalabrutinib has been established in clinical trials like the ELEVATE-TN and ASCEND that have shown an excellent response with a durable remission both in previously untreated CLL and those who relapsed.

Acalabrutinib Side Effects

Although acalabrutinib can be regarded as being safer than the first-generation BTK inhibitors, side effects do exist.

The main adverse effects (20 or more patients):

• Headache (one of the most commonly-reported, but typically non-severe)

• Weakness and extreme tiredness

• Diarrhea, or mild G.I. upset

• Pain in joints (musculoskeletal)

• Infection of the respiratory tract (cough, runny nose, sinus infections)

• Petechiae or bruising 

Rarer but Severe Adverse effects:

• Hematologic toxicity: Reduced neutrophil, hemoglobin and platelets, increased chances of developing infection and bleeding.

• Cardiovascular: Cardiovascular events, atrial fibrillation/flutter, also exist among the patients, but less frequently than that of an ibrutinib.

• Disastrous infections: Such as pneumonia, sepsis or opportunistic viral/fungal infections.

• Secondary tumors: Infrequent cases of secondary skin cancers and other malignancies, which develop, necessitating regular check-ups on the skin.

Based on long-term safety data, acalabrutinib has been proposed to be better tolerated than prior BTK inhibitors on average, with a low rate of discontinuation because of side effects. However, blood tests, ECGs, and infection monitoring are highly recommended as a routine case.

Acalabrutinib Price and buy online

The brand one is very expensive, and it has an extreme cost of thousands of dollars per month in developed markets.

There is currently a range of well-recognized producers of generic acalabrutinib. Generics give equivalent therapeutic results at a small fraction of the price as they have the same active compound.

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• Forms: 100 mg capsules / tablets

• Packaging: 30 capsules in bottles

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Acalabrutinib Safety Advice

Alcohol

Alcohol can increase the liver load; reduce the use.

Pregnancy

Non-safe in pregnancy, may be harmful to the fetus. Have good contraception.

Breastfeeding

Breastfeeding should be avoided; drugs get into the milk and damage the infant.

Driving

Driving may make you dizzy/fatigued; do not drive when ill.

Liver

Closely observe liver functions; warn in patients having liver disease.

Doctor Advice

 Patient needs to check this advice with oncologist before variation in dose or cessation.