Acalabrutinib

So we're excited to see these data mature and we're excited to see what we've achieved with this completed trial and to understand whether our building upon the hypotheses from learning from the PHOENIX trial will bear fruit.

Acalabrutinib is a cleaner drug than ibrutinib.

We all understand that well at this point in time.

And this trial was really looking only up to age 65.

Yeah.

There is also evidence for adding a Bruton's tyrosine kinase or BTK inhibitor to BR, for instance, acalabrutinib BR in the ECHO trial that shows prolonged PFS, although the overall survival data is still maturing.

It's just recently on the PBS, actually, Acala BR for Mantle, I think, in the last few months.

I don't treat a lot of lymphoma.

So, a three-year overall survival of 91% in the chemo, ibrutinib, and autogroup.

And very interestingly, 92% in just the chemo plus ibrutinib without an auto.

So in many places, they take this evidence to say if you can access an upfront BTK inhibitor, then maybe you can actually emit an autologous transplant.

Unfortunately, this combination is not currently accessible in Australia.

This is something that is, the academic community needs to think about because you actually do mention there's a lot of people, you got offered an instructor position and, and so on, and other people get these offers, and it doesn't always play out.

But as we move into the CLL world, we get to learn about you and involvement with Ascerta, uh, Pharma, and acalabrutinib, and all of these things.

And I remember having the podcast when Nathan Vardi had his book for Blood or Money and, and so on.

Mm-hmm.

[laughs] Uh, you know, I wouldn't trade it for the world.

Um, a couple things.

Uh, you know, uh, after ibrutinib came along, uh, two other BTK inhibitors came along before acalabrutinib.

Uh, so, uh, Genentech had one, uh, then a company called Avila had one.

You can see at the bottom the schema, where they, they sort of layered in the different drugs.

Acalabrutinib first, then venetoclax and obinutuzumab.

And the primary endpoint of this study is the PFS comparing the AV arm to the chemo immunotherapy arm with a lot of key secondary endpoints that you see listed there, including a comparison of AVO versus chemo immunotherapy.

Although importantly, the study was not powered to look at a difference between AV and AVO directly.