Real-World Outcomes of Zanubrutinib vs Acalabrutinib in First-Line CLL

In this OncLive Rapid Readout, Ryan Jacobs, MD, reviews a large real-world comparative analysis of first-line zanubrutinib versus acalabrutinib monotherapy in patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). Using the Komodo Healthcare Map claims database, investigators evaluated treatment-naive patients who initiated zanubrutinib or acalabrutinib and compared time to next treatment (TTNT) and overall survival (OS). The study included 5819 patients treated with zanubrutinib and 10,969 treated with acalabrutinib, with inverse probability of treatment weighting used to reduce confounding. Median TTNT and median OS were not reached in either cohort, but Kaplan-Meier and adjusted Cox analyses favored zanubrutinib. Zanubrutinib was associated with a lower risk of next treatment or death and improved OS compared with acalabrutinib. Jacobs discusses how these findings may inform frontline BTK inhibitor selection and support real-world evidence in CLL treatment decision-making across oncology practice.