The New Landscape

Newer treatments are becoming available

In many ways, the last few years have been exciting times for CLL and SLL treatment as they have undergone a radical change. There is now real hope that the disease can be managed, if not yet cured, for many patients. Many of the new treatments are known as ‘targeted therapies’ since they target a very specific part of the defective B call.
Chemotherapy is still an option for many patients as a first-line treatment, and results can be very good. However, it is not suitable for everyone, and there are new treatments becoming available which can offer a good remission.
These are some of the newer targeted therapies you may be offered:

Ibrutinib

Ibrutinib is a targeted drug and an example of a monoclonal antibody which works by blocking signals within cells that are important for their survival. This drug is particularly useful if you have certain genetic characteristics known as 17p deletion, 11q or TP3 mutation.
Ibrutinib is currently used mainly if a first treatment hasn’t worked as well as expected, or if CLL has returned after previous treatment. Ibrutinib is taken in capsule form, usually once a day.

Idelalisib

Idelalisib blocks some of the proteins inside cancerous cells that encourage the cancer to grow. It may be used along with rituximab and can be used to treat you if you have not responded to other treatments. It is taken in tablet form.

Venetoclax

Venetoclax is a new treatment which blocks the growth of CLL cells and promotes cell death. It may be used in conjunction with Rituximab. Currently, Venetoclax is used if a first treatment hasn’t worked as well as expected, or if CLL has returned after previous treatment. It is taken in capsule form once a day.

Acalabrutinib

This is another new drug which, at the time of writing, is still undergoing trials and is awaiting approval and funding. It is a development of Ibrutinib and is taken in tablet form. We will keep you updated on when this drug may become available for patients.

Chimeric Antigen Receptor T cells (CAR-T cells)

In CLL, the normal immune system has become very weak. In CAR-T cell therapy, a CLL patient’s T cells are removed, manipulated in a laboratory to make them better able to kill CLL cells. They are then returned to the patient. At present CAR-T cell therapy is not available for CLL, and it is still at an experimental stage.

For an overview of CLL, current and future treatment see the presentation by Dr Renata Walewska’s talk at our recent Bournemoth conference here: