What is acalabrutinib (Calquence®)?

Acalabrutinib is used to treat chronic lymphocytic leukaemia (CLL). It is best to read this information with our general information about the type of cancer you have. 

Acalabrutinib is a type of drug called a Bruton tyrosine kinase inhibitor (TKI) and belongs to a group of targeted therapy drugs known as cancer growth inhibitors. Kinases are proteins in the body that control how the cells grow and divide.

Acalabrutinib blocks the proteins (kinases) from sending signals to the cancer cells to grow. Blocking the signals causes the cells to die. This may help to stop the cancer growing. Or it may grow more slowly.

Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.

How acalabrutinib is given

Acalabrutinib comes as capsules so you can take them at home. You usually have it on its own.

During treatment you usually see a cancer doctor, a cancer nurse or specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.

You will have regular blood samples taken to check different things. For example, the level of your blood cells and how well your liver and kidneys are working. 

Your doctor, nurse or pharmacist will discuss your treatment plan with you. They will explain how to take acalabrutinib. You may be given other medicines to take home. Take all your medicines exactly as your doctor or pharmacist tell you.

You usually carry on taking acalabrutinib for as long as it is working for you and any side effects can be managed. Do not stop taking acalabrutinib without talking to your doctor first.

Taking acalabrutinib tablets

You will need to take acalabrutinib capsules twice a day. They are usually taken every 12 hours. Take the capsules at the same time each day. Swallow the capsules whole with water, with or without food. Do not chew, dissolve, or open the capsules.

Always take acalabrutinib exactly as your nurse or pharmacist explained. This is important to make sure it works as well as possible. 

If you forget to take your capsules, and it is less than 3 hours after your usual time, you can take the missed dose. Take your next dose at the regular time.

If more than 3 hours have passed, do not take your missed dose. Wait and take the next dose at the usual time. Do not take a double dose to make up for the missed one.

If you are sick just after taking the capsule, take the next dose as usual. Do not take another dose.

Before you start treatment with acalabrutinib, you should tell your doctor if you take medicine to reduce stomach acid. Some of these medicines cannot be taken whilst taking acalabrutinib as they can cause significant side effects. If you take medicines to reduce stomach acid, your doctor, nurse or pharmacist can tell you more about which types of these medicines can be used and when you can take them.

Other things to remember about your capsules:

  • Keep them safe, somewhere that children cannot see or reach them
  • Keep them in the original package and at room temperature, away from heat and direct sunlight.
  • It is important to get a new prescription before you run out of tablets. Make sure you have plenty for holidays.
  • If your treatment is stopped, return any unused tablets to the pharmacist.

About side effects

We explain the most common side effects of this treatment here. We also include some less common side effects.

You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.

Common side effects

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is sometimes called neutropenia.

Your doctor may give you antibiotics and other drugs to try to stop you getting an infection. These are called prophylactic medicines.

An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. Contact the hospital straight away on the 24-hour contact number you have been given if:

  • your temperature goes over 37.5°C (99.5°F)
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection
  • your temperature goes below 36°C (96.8°F).

Symptoms of an infection include:

  • feeling shivery and shaking
  • a sore throat
  • a cough
  • breathlessness
  • diarrhoea
  • needing to pass urine (pee) a lot, or discomfort when you pass urine.

It is important to follow any specific advice your cancer treatment team gives you.

You will have regular blood tests during treatment. If needed, your doctor may reduce or delay your treatment for a short time, until your cell count increases.

Bruising and bleeding

This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.

If the number of platelets is low, you may bruise or bleed easily. You may have:

  • nosebleeds
  • bleeding gums
  • heavy periods
  • blood in your urine (pee) or stools (poo)
  • vomiting or coughing up blood
  • tiny red or purple spots on your skin that may look like a rash.

Tell your doctor straight away if you have any unexplained bruising or bleeding. You may need a drip to give you extra platelets. This is called a platelet transfusion.

Tell your doctor if you are taking any medicines that thin the blood or prevent blood clots. These can increase your risk of bleeding.

If you need to have any surgery, your doctor may ask you to stop taking acalabrutinib for a few days before and after your operation.

Anaemia (low number of red blood cells)

This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may have symptoms such as:

  • pale skin
  • lack of energy
  • feeling breathless
  • feeling dizzy and light-headed.

Tell your doctor or nurse if you have these symptoms.

If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

Headaches

This treatment may cause headaches. If you have headaches, tell your doctor. They may give you painkillers to help.

Diarrhoea

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.

If you have diarrhoea:

  • try to drink at least 2 litres (3½ pints) of fluids each day
  • avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
  • contact the hospital for advice.

Tummy pain

This treatment can cause pain in the tummy (abdomen). Your doctor or nurse can suggest treatments to help.

Constipation

This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:

  • Drink at least 2 litres (3½ pints) of fluids each day.
  • Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
  • Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.

Muscle or joint pain

You may get pain in your muscles or joints. If this happens, tell your doctor so they can give you painkillers. Tell them if the pain does not get better. Having warm baths and taking regular rests may help.

Feeling sick

Your doctor can prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. If you still feel sick, tell your doctor. They can prescribe other anti-sickness drugs that may work better for you.

Feeling tired

Feeling tired is a common side effect of this treatment. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy.

If you feel sleepy, do not drive or use machinery.

Effects on the skin

This treatment can cause a skin rash. Tell your doctor or nurse if you develop a rash.

Acalabrutinib can increase your risk of skin cancer. It is important to have regular skin examinations and protect your skin from sunlight. If you are out in the sun, cover up, wear a hat and use sun cream with a high sun protection factor (at least SPF 30) to protect your skin.

Always tell your doctor or nurse about any changes to your skin.

Second cancer

This treatment can increase the risk of developing a second cancer. The benefits of treatment usually far outweigh this risk. Your doctor can talk to you about this.

Tumour lysis syndrome (TLS)

This treatment may cause cancer cells to die and break down very quickly. When cancer cells break down, it can lead to a sudden release of chemicals into the blood. This is called tumour lysis syndrome (TLS).

Your kidneys can usually keep these chemicals in balance, but they might not be able to cope with very large amounts. The chemical imbalance can affect how well your kidneys work and cause problems with your heart rhythm. 

You will have regular blood tests to check the levels of these chemicals. 

If you are at risk of TLS, your doctor can give treatment to help prevent it. You may have:

  • extra fluids through a drip
  • medicines such as rasburicase or allopurinol

Drinking at least 2 litres (3½ pints) of fluid a day will also help.

Less common side effects

Effects on the nervous system

Acalabrutinib can affect the nervous system. You may feel dizzy or unsteady.

Tell your doctor or nurse straight away if you notice this. They may make some changes to your treatment if it becomes a problem for you.

It is important not to drive or operate machinery if you notice these effects.

Very rarely, this treatment can cause a condition called PML (progressive multifocal leukoencephalopathy). Symptoms include:

  • difficulty speaking
  • difficulty with walking or movement 
  • memory loss
  • confusion
  • changes in your eyesight.

Contact the hospital straight away if you have any of these symptoms. It is important not to drive or operate machinery if you notice these effects.

Effects on the heart

This treatment can affect how the heart works. You may have tests to see how well your heart is working. These may be done before, during and after treatment.

If the treatment is causing heart problems, your doctor may change the type of treatment you are having.

Contact your doctor straight away on the 24-hour number the hospital has given you if you have any of these symptoms during or after treatment:
  • pain or tightness in your chest
  • breathlessness
  • dizziness
  • changes to your heartbeat.

Other conditions can cause these symptoms, but it is important to get them checked by a doctor. If you cannot get through to your doctor, call the NHS urgent advice number on 111.

Other information

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

  • throbbing pain, redness or swelling in a leg or arm
  • suddenly feeling breathless or coughing
  • sharp chest pain, which may be worse when you cough or take a deep breath.

If you have any of these symptoms, contact the hospital straight away on the 24-hour contact number you have been given. If you cannot get through to your doctor, call the NHS urgent advice number on 111.

A blood clot is serious, but it can be treated with drugs that thin the blood (anticoagulants). Your doctor or nurse can give you more information.

You can help reduce the risk of developing a blood clot by:

  • staying active during treatment
  • drinking plenty of fluids, especially water.

You may be given anticoagulants to help prevent a clot.

Hepatitis B reactivation

If you have had hepatitis B (a liver infection) in the past, this treatment can make it active again. Before starting acalabrutinib you usually have a blood test for hepatitis B. Your doctor or nurse will talk to you about this.

Other medicines

Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:

  • medicines you have been prescribed
  • medicines you buy in a shop or chemist
  • vitamins, herbal drugs and complementary therapies.

Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.

You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.

Vaccinations

Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.

Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations.

If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines, such as shingles, contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated vaccinations.

Contraception

Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.

Fertility

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Breastfeeding

You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.

Your doctor or nurse can give you more information.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.

About our information


  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert health professionals and people living with cancer.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.