Are there new CLL treatment approaches that patients should know about? Dr. Brian Hill reviews the “explosion of new treatments” in the past few years.
Dr. Brian Hill is the Director of the Lymphoid Malignancies Program at Cleveland Clinic. More about this expert.
Dr. Brian Hill:
So, there’s been an explosion of new treatments for CLL just in the past five years. As of before 2014, most of the treatment we had involved both traditional chemotherapy drugs with antibodies.
Those antibodies include Rituximab and more recently other antibodies such as obinutuzumab. The explosion that I’m referring to is really in the development of very effective and generally well tolerated targeted agents. The most well known in the first one of these was Ibrutinib which inhibits a protein that tells the CLL cells to grow and divide called BTK. There are other blockers or inhibitors of BTK that are now approved include Acalabrutinib. The side effect of these are slightly different, and there are reasons why you might choose one or the other.
There’s also a very potent medication called Venetoclax which is now used – which has a different mechanism of action than BTK blockers.
Many of these work better when you combine them with the antibodies I mentioned. And so right now a lot of the research that’s ongoing is examining the utility of combining these agents or how to best sequence them. So, much of the decision about how we can best treat patients is derived from really well done, well designed clinical trials. And sometimes clinical trials can give patients an option that’s not yet a standard but is likely to become a standard.
Or it can give you access to a drug that is promising and not yet widely available. So, there are definitely times to seek – at least ask the question whether a clinical trial is a good option or the best option.
And there may be times where it is not appropriate, and the standard treatments are very reasonable and may require fewer visits to a referral center to be treated. So, I think it’s worth having that conversation both with the primary hematologist/oncologist as well as the CLL specialist.