Zanubrutinib versus acalabrutinib indirect treatment comparison in relapsed or refractory mantle cell lymphoma

Zanubrutinib and acalabrutinib have demonstrated efficacy in separate single-arm clinical trials in patients with relapsed/refractory (R/R) mantle cell lymphoma (MCL). Given these single-arm trials lacked a common comparator, an unanchored indirect treatment comparison was conducted to assess the comparative efficacy of zanubrutinib versus acalabrutinib using a simulated treatment comparison (STC) method. In the base case analysis (adjusted for all covariates), zanubrutinib treatment was associated with significantly improved progression-free survival (hazard ratio [HR], 0.57 [95% confidence interval [CI], 0.35-0.94]; <i>p</i> = 0.0272) and overall survival (HR, 0.43 [95% CI, 0.23-0.82]; <i>p</i> = 0.0105) versus acalabrutinib. Overall response rate was numerically higher with zanubrutinib versus acalabrutinib (odds ratio [OR], 2.05 [95% CI, 0.72-5.84]; <i>p</i> = 0.1798). Sensitivity analyses, including a subset of covariates, provided consistent results. In the absence of a head-to-head trial, these results provide important insights into the comparative efficacy of zanubrutinib and acalabrutinib for physicians managing patients with R/R MCL.