Targeted therapy for chronic lymphocytic leukaemia (CLL)
Targeted therapies are drugs that target something that is helping the cancer cells grow and survive. Most people with CLL are treated with a combination of targeted therapy and chemotherapy.
Targeted therapies are drugs that target something that is helping the cancer cells grow and survive. Because these drugs only ‘target’ the cancer cells, they have less effect on healthy cells.
There are different types of targeted therapy. They all act in different ways and have different side effects. Your haematologist can tell you which treatments may be suitable for you.
Monoclonal antibodies treat CLL by targeting proteins on white blood cells called B-lymphocytes (B-cells). This makes the B-cells die.
Monoclonal antibodies are usually given with chemotherapy. Some monoclonal antibodies are also immunotherapies. When these drugs are given with chemotherapy this is sometimes called chemoimmunotherapy.
Monoclonal antibody treatments used for CLL include:
Alemtuzumab is also occasionally used to treat CLL.
How monoclonal antibodies are given
Monoclonal antibodies are usually given into a vein as a drip. You can have them as an outpatient. Some people may be asked to stay in hospital overnight for their first treatment.
Some people may have a reaction during the infusion. A reaction is more likely with the first infusion, so it is given slowly over a few hours. Reactions are usually milder after the first infusion. You are also given medicines before each infusion to help prevent or reduce any reaction.
Symptoms of a reaction can include:
- a high temperature
- shivering and shakes
- a rash
- low blood pressure
- feeling sick (nausea).
If you have any of these symptoms or feel unwell during or soon after an infusion, tell your nurse or doctor immediately.
Alemtuzumab may be given as an injection under the skin (subcutaneously). In this case, it is less likely to cause a reaction.
BCR inhibitors are another type of targeted therapy. They work by targeting proteins called B-cell receptors on the surface of the CLL cells. B-cell receptors control how CLL cells grow. If they are switched off, the CLL cells die. Two drugs that can be used for CLL are ibrutinib (Imbruvica®) and idelalisib (Zydelig®).
BCR inhibitors target the B-cell receptors to stop the cancer growing and dividing. You may be given a BCR inhibitor:
- if CLL comes back after chemoimmunotherapy treatment
- as a first treatment instead of chemoimmunotherapy if you have CLL with a p53 deletion or p53 mutation.
You take BCR inhibitors as tablets or capsules every day. You usually continue taking them for as long as they are working.
One of the reasons that CLL cells continue to grow is that they make too much of a protein called BCL2. BCL2 inhibitors work by blocking (inhibiting) this protein. This helps kill the CLL cells.
Your haematologist may suggest treatment with a BCL2 inhibitor called venetoclax (Venclyxto®) if:
- you have CLL with a p53 deletion or p53 mutation, and BCR inhibitors are not suitable for you or are no longer working
- chemotherapy and other targeted therapy treatments have not worked for you.
You take venetoclax as tablets. You may have it with other treatments. This drug may only be available in some situations. Your haematologist can tell you if it is suitable for you.
Different targeted therapies can have different side effects. Your doctor, nurse or pharmacist will explain the possible side effects of the specific drugs you are having before you start your treatment.
Below is a sample of the sources used in our chronic lymphocytic leukaemia (CLL) information. If you would like more information about the sources we use, please contact us at email@example.com
Eichhorst, et al. Chronic lymphocytic leukaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2015. Vol 26 (Supplement 5), pp. 78-85. ESMO 2017: Chronic Lymphocytic Leukaemia treatment recommendations: eUpdate: www.esmo.org/Guidelines/Haematological-Malignancies/Chronic-Lymphocytic-Leukaemia/eUpdate-Treatment-Recommendations.
National Institute for Health and Care Excellence: www.nice.org.uk.
Routledge D, and Bloor A. Recent advances in therapy of chronic lymphocytic leukaemia. British Journal of Haematology. 2016. 174, pp. 351-367.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Helen Marr, Consultant Haematologist.
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