Read about having targeted cancer drugs as a treatment for chronic lymphocytic leukaemia.

Targeted cancer drugs are treatments that change the way cells work and help the body to control the growth of cancer.

Our immune system works to protect us against diseases, including cancer. It normally picks up faulty cells and destroys them. Sometimes the immune system misses these and cancer develops. Scientists are working on ways to trigger the immune system so it can target cancer cells.

Monoclonal antibody treatment

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.

Monoclonal antibody drugs

Rituximab (Rituxan)

Rituximab works by seeking out a protein called CD20 found on normal and leukaemic white blood cells (lymphocytes). Once it has found the lymphocytes, it sticks to them and the immune system then targets the cells and kills them. Normal lymphocytes then grow to replace those that are destroyed.

You might have rituximab with the chemotherapy drugs:

• fludarabine
• cyclophosphamide 

This combination, usually called FCR, is the most commonly used first treatment for people with CLL who are physically fit.

Alemtuzumab (Campath 1H)

Alemtuzumab is also called Mabcampath, Campath, or Campath 1H. You are most likely to have alemtuzumab if your CLL has stopped responding to chemotherapy or has come back after chemotherapy treatment. But alemtuzumab may sometimes be useful as a first treatment for physically fit people with CLL.

You might have alemtuzumab with a steroid (methylprednisolone) if your CLL is found to have a change (mutation) in the p53 gene.

Alemtuzumab works best in patients with CLL who don't have a lot of very enlarged lymph nodes. It works by finding and attaching itself to the cancerous white blood cells (lymphocytes) and then killing them.

Ofatumumab (Arzerra)

Ofatumumab targets part of a protein called CD20 on the surface of the CLL cells. The ofatumumab sticks to all the CD20 proteins it finds. Then all the cells of the immune system pick out the marked cells and kill them.

Other targeted drugs

Venetoclax (Venclyxto)

Most CLL cells make a high amount of a protein called BCL-2. Sometimes this protein can stop the cancer treatment from working, allowing the cancer cells to grow. Venetoclax blocks the protein, so the cells can no longer divide and grow.

Venetoclax is for some adults with CLL that have had at least one other treatment. You may have it with rituximab. Some people might have it on its own. Do speak to your doctor, they can tell you if it’s suitable for you. 

Side effects

The side effects of targeted drugs vary according to the particular drug you are having. You may have a few side effects. They can include:

• an allergic reaction
• diarrhoea
• tiredness
• flu-like symptoms including fever, muscle aches and sickness
• low blood counts

When you go home

Treatment with targeted drugs can be difficult to cope with for some people. Your nurse will give you a number to call (advice line) if you have any problems at home.