Mantle cell lymphoma (MCL) is a form of non-Hodgkin lymphoma, a cancer affecting the lymphatic system. The management of cancer has been altered by treatments that focus on specific cellular targets. This article provides an overview of acalabrutinib and its role in managing MCL.
Understanding Mantle Cell Lymphoma
Mantle cell lymphoma is a rare, often aggressive type of B-cell non-Hodgkin lymphoma. It arises from the abnormal growth of B-lymphocytes in a region of the lymph node called the mantle zone. This disease accounts for about 6% of all non-Hodgkin lymphoma cases in the United States and is more commonly diagnosed in men over 60.
A primary biological feature of MCL is the overproduction of a protein called cyclin D1. This is caused by a genetic translocation between chromosomes 11 and 14, which leads to the dysregulation of the cyclin D1 gene. The excess protein pushes cells to multiply uncontrollably, contributing to the lymphoma’s development and progression.
MCL is often diagnosed at a late stage, which can make it challenging to treat. By the time of diagnosis, cancer cells have frequently spread to the bone marrow, spleen, and gastrointestinal tract. Common symptoms include swollen lymph nodes, fatigue, fever, night sweats, and abdominal distention from an enlarged spleen or liver.
Acalabrutinib as a Targeted Therapy
Acalabrutinib, sold under the brand name Calquence, is a medication used to treat adults with MCL. It belongs to a class of drugs known as Bruton’s tyrosine kinase (BTK) inhibitors. This is a form of targeted therapy, which differs from traditional chemotherapy by acting on specific molecules involved in cancer cell growth and survival.
Unlike chemotherapy, which can affect all rapidly dividing cells, targeted therapies like acalabrutinib interfere with particular pathways that cancer cells depend on. This focused approach aims to disrupt cancer cells while minimizing harm to healthy cells. This can also lead to different side effect profiles compared to conventional treatments.
Acalabrutinib is approved for adult patients with MCL who have received at least one prior therapy. It offers an option for patients whose disease has returned or has not responded to initial treatment. The therapy is designed to slow the cancer’s progression and manage the disease long-term.
Acalabrutinib’s Mechanism in Mantle Cell Lymphoma
The effectiveness of acalabrutinib lies in its ability to interfere with a specific signaling pathway inside cancer cells. It works by targeting a protein called Bruton’s tyrosine kinase (BTK). BTK is a component of the B-cell receptor signaling pathway, which is essential for the survival and multiplication of B-cells, including those in mantle cell lymphoma.
When this signaling pathway is activated, it sends messages that tell the B-cell to stay alive and divide. In MCL, this pathway is often overactive, contributing to the uncontrolled growth of the lymphoma cells. Acalabrutinib functions by binding directly and irreversibly to the BTK protein, which blocks its ability to send signals downstream.
By inhibiting BTK, acalabrutinib disrupts the survival communications within the MCL cells. This interruption halts the signals that promote cell proliferation and survival, leading to the death of the cancerous B-cells. The drug’s high selectivity for the BTK protein helps to focus its effects on the cancer cells.
Administering Acalabrutinib for Mantle Cell Lymphoma
Acalabrutinib is an oral medication, prescribed as a 100 mg capsule or tablet to be taken twice daily. The doses are spaced approximately 12 hours apart. Patients should swallow the medication whole with a glass of water and should not crush, chew, or dissolve it.
This treatment can be taken with or without food, offering flexibility. It is important to adhere to the prescribed schedule. If a dose is missed by more than three hours, the patient should skip that dose and take the next one at its regularly scheduled time. Do not take extra capsules to make up for a missed dose.
Treatment with acalabrutinib is continued until the disease progresses or the patient experiences unmanageable side effects. The therapy is intended to keep the lymphoma under control. A healthcare provider will provide all specific instructions regarding dosage and administration.
Potential Side Effects and Management with Acalabrutinib
Patients taking acalabrutinib may experience a range of side effects. The most common effects are manageable and do not always lead to stopping treatment. These include headache, diarrhea, fatigue, muscle aches, and bruising. Low blood cell counts, including anemia (low red blood cells), neutropenia (low white blood cells), and thrombocytopenia (low platelets), are also reported.
Less common but more serious side effects can occur. These include an increased risk of infections, major bleeding, and irregular heartbeats like atrial fibrillation. There is also a potential for developing other cancers, particularly skin cancer, so patients are advised to use sun protection.
Healthcare teams monitor patients for these potential issues throughout treatment. Management strategies may involve supportive care, dose adjustments, or pausing treatment if side effects become severe. Patients should report any new or worsening side effects to their doctor promptly for safe and effective management.