Find out about the current UK research into treating chronic lymphocytic leukaemia.
Research and clinical trials
All cancer treatments must be fully researched before they can be used for everyone. This is so we can be sure that:
- they work
- they work better than the treatments already available
- they are safe
Chemotherapy is commonly used to treat chronic lymphocytic leukaemia. Research is looking into new chemotherapy drugs, or combinations, in order to improve treatment. Some trials are looking at combining chemotherapy with targeted cancer drugs to see if they can control CLL better than chemotherapy alone.
Targeted cancer drugs
Targeted cancer drugs are treatments that change the way cells work and help the body control the growth of cancer.
Some seek out and destroy cancer cells. Others help the body attack the cancer.
A type of targeted cancer drug called a monoclonal antibody (MAB) can be used to treat chronic lymphocytic leukaemia (CLL). An antibody is a protein that is attracted to a particular type of cell.
Monoclonal antibodies are multiple copies of an individual antibody. Those used for CLL may disrupt the leukaemia cell processes so that the cell stops dividing or dies.
The MABs may also stick to the leukaemia cells and trigger the immune system to destroy them.
A monoclonal antibody called alemtuzumab (MabCampath) is currently used to treat people with CLL whose leukaemia has not responded well to chemotherapy.
Doctors are interested in:
- giving alemtuzumab as an injection just under the skin instead of through a drip into a vein
- whether alemtuzumab can kill off leukaemia cells left behind after chemotherapy treatment (minimal residual disease)
- combining the drug with other targeted treatments
Researchers are looking at the drug ofatumumab (Arzerra). This monoclonal antibody targets the CD20 protein.
- comparing ofatumumab to other treatments for CLL that has got worse or has come back
- looking at ofatumumab with chemotherapy for people with CLL who cannot have intensive treatment
- investigating different doses of ofatumumab
This is a new type of monoclonal antibody. It is also known as GA101 and Gazyvaro.
The Scottish Medicines Consortium (SMC) have said that obinutuzumab should be available as a treatment for people within the NHS in Scotland. They say it should be available for people as a first treatment and who are unable to have fludarabine chemotherapy because of their other health problems.
The National Institute for Health and Care Excellence (NICE) say obinutuzumab can be given in combination with chlorambucil for people who have not had previous treatment. It is for people who cannot have fludarabine because of other health problems, or who are not suitable for treatment with bendamustine.
Researchers are looking at whether having obinutuzumab after chemotherapy reduces the risk of CLL coming back.
Ibrutinib (Imbruvica) is a type of cancer growth blocker. It stops signals that cancer cells use to divide and grow.
Researchers are looking at:
- how well ibrutinib works for CLL
- combining ibrutinib with other targeted cancer drugs
- adding ibrutinib to chemotherapy
Some doctors are using ibrutinib in trials for patients who have not yet had treatment for CLL.
Lenalidomide is a drug used for myeloma. This drug is also called Revlimid or Celgene. It is being used in trials for CLL.
Although the details of how lenalidomide works are not known, it is thought that it triggers the immune system to recognise the CLL cells. It has been used for patients who have relapsed or whose disease is difficult to treat (refractory).
Scientists are investigating:
- if lenalidomide helps to stop CLL coming back after having two previous types of chemotherapy
- if lenalidomide helps patients whose CLL has stopped responding to treatment
- using the drug as a first treatment for CLL
Newer targeted cancer drugs
There are a lot of newer targeted treatments that scientists are looking at for treating CLL.
- duvelisib (IPI-145)
Idelalisib (Zydelig) blocks a protein called PI3K (it is a PI3K inhibitor) and helps stop cancer cell growth.
The Scottish Medicines Consortium (SMC) have recommended Idelalisib (Zydelig) for people with CLL living in Scotland. In England and Wales, the National Institute for Health and Care Excellence (NICE) have approved idelalisib for some people with CLL. You may have it if you have not had any treatment yet, and your CLL has certain genetic changes. Or if you have had treatment, but your CLL has come back (relapsed) within 2 years.
Research is ongoing to see exactly how delalisib works in people with CLL.
Researchers are looking at a new combination of drugs to treat types of leukaemia and lymphoma including CLL. The drugs are bezafibrate, which lowers cholesterol in the blood, and medroxyprogesterone, which is a steroid.
Cyclosporin A (CsA) can reduce the activity of your immune system and may affect the rate at which leukaemia cells grow. Researchers want to find out:
- if CsA changes the rate at which leukaemia cells grow and how long they live
- if CsA helps people with CLL
- more about the side effects of CsA
CLL cells don't generally show up very well to the immune system. If we can find a way to make the cells show up more clearly, then the immune system may attack the leukaemia cells and so help to control the leukaemia. This is vaccine research. There are several different ways of making cancer cells show up more clearly to immune system cells.
There has been research into making vaccines:
- from a patient's own CLL cells
- using specialised blood cells called dendritic cells
- by attaching proteins to CLL cells that will help the immune system to find and kill other CLL cells
This is all very early research and so far, most of it has been lab based, rather than with patients. It will be some years (if ever) before any of these vaccines can become available as a standard treatment.