Acalabrutinib (Calquence®)

Acalabrutinib comes as tablets or capsules so you can take them at home. 

During treatment you usually see a:

• cancer doctor
• cancer nurse or specialist nurse
• specialist pharmacist. 

This is who we mean when we mention doctor, nurse or pharmacist in this information.

Before you start treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is safe for you to have treatment. You will have regular blood samples taken throughout the course of your treatment.

Your doctor, nurse or pharmacist will discuss your treatment plan with you. The nurse or pharmacist will give you the acalabrutinib capsules to take home. Always take them exactly as explained. This is important to make sure they work as well as possible for you. You may be given capsules of different strengths.

Your nurse or pharmacist may also give you anti-sickness drugs and other medicines to take home. Take all your capsules or tablets exactly as they have been explained to 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.

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

If you forget to take your acalabrutinib, and it is less than 3 hours after your usual time, you can take the missed dose. Then take the 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. 

Before you start treatment with acalabrutinib capsules, you should tell your doctor if you take medicine to reduce stomach acid. Some of these medicines cannot be taken whilst taking acalabrutinib capsules. 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 tablets or capsules:

• Keep them safe, somewhere that children cannot see or reach them.
• Keep them in the original package and at room temperature, away from moisture, heat and direct sunlight.
• It is important to get a new prescription before you run out of tablets or capsules. Make sure you have plenty for holidays.
• If you are sick just after taking the tablets or capsules, contact the hospital. Do not take another dose.
• If your treatment is stopped, return any unused tablets or capsules to the pharmacist.

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

An infection can be very serious when the number of white blood cells is low. Your doctor may give you antibiotics and other drugs to take during this treatment. These may help reduce your risk of getting an infection. 

But it is still important to get any infection treated as soon as possible. If you have any of the following symptoms, contact the hospital straight away on the 24-hour number:

• a temperature above 37.5°C 
• a temperature below 36°C
• you feel unwell, even with a normal temperature
• you have symptoms of an infection.

Symptoms of an infection include:

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

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

Your white blood cell count will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time, until your cell count increases.

You may be given a drug called G-CSF. This encourages the body to make more white blood cells. You have it as a small injection under the skin.

This treatment can increase the risk of getting a chest infection (pneumonia). You will be given antibiotics to take during your treatment to reduce this risk. You may also take antibiotics for a few months after treatment has finished. Contact your doctor straightaway if you have any of the following symptoms:

• a cough
• breathlessness
• coughing up mucus (phlegm)
• a fever, with a temperature over 37.5°C (99.5°F).

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.

If you have any unexplained bruising or bleeding, tell your doctor straight away. 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 surgery, your doctor may ask you to stop taking acalabrutinib for a few days before and after your operation.

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 feel:

• very low in energy
• breathless 
• dizzy and light-headed. 

If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

This treatment may cause headaches. If you have headaches, tell your doctor, nurse or pharmacist. They can give you advice about painkillers that may help. Tell them if the headache does not get better, or gets worse.

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

If you are passing loose stools 3 or more times a day and this is not normal for you, contact the hospital as soon as possible on the 24-hour number. Follow the advice they give you about:

• taking anti-diarrhoea medicines 
• drinking enough fluids to keep you hydrated and to replace lost salts and minerals
• any changes to your diet that might help. 

They might also ask you for a specimen of your stool to check for infection.

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 on the 24-hour number for advice. They can give you drugs called laxatives to help. 

If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away. 

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

Your doctor can prescribe anti-sickness drugs to prevent or control sickness during your treatment. If you feel sick or are sick (vomit), tell your nurse or doctor. They may change the anti-sickness drug to one that works better for you.

Feeling tired is a common side effect. Try to pace yourself and plan your day so you have time to rest between activities.

Being physically active can help to manage tiredness and give you more energy. It also:

• helps you sleep better
• reduces stress
• improves your bone health.

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

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, protect your skin by:

• covering up
• wearing a hat 
• using sun cream with a high sun protection factor (at least SPF 30). 

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

Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

• throbbing pain or swelling in a leg or arm
• reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
• suddenly feeling breathless or coughing.

Always call 999 if you have:

• chest pain
• difficulty breathing.

A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.

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

• medicines you have been prescribed
• medicines you buy in a shop, pharmacy or online
• vitamins or supplements 
• herbal drugs and complementary or homeopathic therapies
• recreational drugs – for example, cannabis.

Doctors usually recommend that people with cancer have vaccinations for flu and for coronavirus (covid). These help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

If your immune system is weak, you should not have live vaccinations. Live vaccines can make you unwell because they contain a very weak version of the illness they will protect you against. Live vaccines include Zostavax^®, which is a shingles vaccine, and the yellow fever vaccine.

It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.

Your doctor, nurse or pharmacist will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm a developing baby. It is important to use contraception to prevent pregnancy. Follow their advice about:

• what types of contraception to use 
• how long after treatment you should continue to use contraception. 

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.

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

Your doctor, nurse or pharmacist can give you more information.

If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.