Real-world Study of Acalabrutinib

Acotinib is a highly selective, irreversible second-generation Bruton tyrosine kinase (BTK) inhibitor. NMPA approved acotinib in March 2023 for R/R MCL (≥1 prior therapy), in August 2023 for R/R CLL/SLL (≥1 prior therapy), and in March 2025 for first-line treatment of treatment-naïve CLL.

The phase III ChangE study (Qiu et al., 2024 ASH Poster 642) demonstrated the efficacy of acotinib in Asian patients with treatment-naïve CLL: 155 patients randomized 1:1 to acotinib (100 mg orally twice daily, continuous) or chlorambucil plus rituximab (6 cycles) across 44 study sites in mainland China, Taiwan (China), Vietnam, Thailand, and the Philippines; the Chinese cohort comprised 103 patients from 30 sites. At a median follow-up of 23.5 months (overall) and 18.2 months (Chinese cohort), acotinib reduced the risk of disease progression or death by 92% as assessed by blinded independent central review (HR=0.08; P<0.0001), with median PFS not reached versus 15.5 months and a 24-month PFS rate of 92% versus 25%; no new safety signals were identified.

Despite these pivotal data, real-world evidence on acotinib in routine Chinese clinical practice-including treatment patterns, dose modifications, long-term safety, effectiveness in real-world populations, and minimal residual disease (MRD) outcomes-remains limited.

The RESA study is a prospective, nationwide, multicenter, non-interventional, observational cohort study designed to describe acotinib real-world treatment patterns, dosing, safety, and effectiveness in Chinese patients with CLL/SLL and MCL treated according to the local prescribing label. Approximately 30 study sites are anticipated. The target sample size is approximately 160 patients (~901L CLL/SLL, ~30 R/R CLL/SLL, ~40 R/R MCL); enrollment will terminate at the earlier of ~160 patients enrolled or 46 months of enrollment. The exploratory endpoint of MRD negativity rate was newly added in protocol v2.0; MRD assessment (sample type, sampling method, detection method, and threshold per routine practice) will be captured at baseline and follow-up.

Inclusion criteria

• 1: Patients should be ≥18 years old at diagnosis
• 2: Diagnosed as MCL who have received at least one prior therapy, OR diagnosed as CLL/SLL who are treatment-naïve or have received at least one prior therapy (per the local prescribing label for acalabrutinib)
• 3: Eligible for acalabrutinib treatment assessed by investigators (physician's evaluation) in clinical practice
• 4: Patient/legal guardian must be able to read, understand, and sign the informed consent form (ICF)

Exclusion criteria

• 1: Ineligible for acalabrutinib treatment assessed by investigators (physician's evaluation)
• 2: Progression after accepting other BTKi treatment before use of acalabrutinib
• 3: Concurrent participation in another interventional clinical study
• 4: Females of childbearing potential must practice highly effective contraception during treatment of acalabrutinib, and for at least 1 week after the last dose of acalabrutinib, and have a negative urine or serum pregnancy test ≤ 7 days before the first dose of study drug(s).
• 5: No requirement to use contraception for male subjects treated with acalabrutinib. a. A sterile male is considered a highly effective contraception method for female patients. b. Males with known "low sperm counts" (consistent with "sub-fertility") are not to be considered sterile for purposes of this study.