New Directions for Treatment of Chronic Lymphocytic Leukemia (CLL)

As a cancer research blogger I have an interest in all research on all cancers. That’s really what this blog is all about.

But as an individual, I have a special interest in chronic lymphocytic leukemia (CLL) for very personal reasons: my sister-in-law Rachelle was diagnosed with CLL in 1999 and has been living with this since then.

CLL is one of those cancers that typically does not develop in people as young as Rachelle (who was in her late 30’s when first diagnosed), although this earlier onset seems to be an increasing phenomenon. CLL is one of those cancers that usually stays “indolent” or fairly quiet for a while, sometimes quite a while. During this phase there are often mild symptoms but nothing that most people can’t manage. But sooner or later it will rear its ugly head and the symptoms worsen, making some form of treatment necessary.

In Rachelle’s case the treatment was a mild form of chemotherapy that did knock her blood counts back to normal and relieved most of the symptoms but the “remission” period did not last as long as her oncologist would have hoped for. Now the disease was back and stronger, requiring a more aggressive approach.

The problem with the chemotherapy approaches that were available  to her at the time was that they too could be expected to be temporary. Just how long she could keep the disease in check would remain to be seen, but if that regimen failed to hold the cancer in remission there would be very few options for her at that stage, short of a bone marrow transplant.

Rachelle was in the right place at the right time, however, and in early 2009 was eligible for a clinical trial of a new experimental drug combination (new in Canada at least). The combo consisted of two standard drugs, fludarabine and cyclophosphamide but included a new drug in the mixture – rituximab. The mixture is abbreviated as FCR. A second new drug, lumiliximab was also being tested in half the patients.

I am happy to report that after six rounds of chemo (Rachelle was randomly placed on the arm with all 4 drugs), her disease has all but disappeared. Her oncologist has declared her to be in complete remission, and as of this writing her blood counts are indistinguishable from normal. We hope that lasts forever, of course.

But if it doesn’t it is comforting and exciting to know that there are a number of new drugs currently in development that look extremely promising, at least in early studies. These drugs are from a class of molecules called kinase inhibitors, and they interfere with the ability of the cancer cells to receive signals that tell them to keep growing uncontrollably.

This new class of drugs has been in development for many cancers, and have now been making some headlines for the possible treatment of CLL.

I have included below a video of Dr. Susan O’Brien of the M.D. Anderson Cancer Center in Houston who talks about these approaches and how their potential is very exciting, not only because of the possible effects of the drugs, but also because of the lowered toxicity and side effects of the drugs in development, most notably the fact that the patient’s immune systems seem to fare better that when using the standard trio of FCR.

I hope that Rachelle never needs any further treatment, but I am glad that the development of new approaches to CLL is going on at great speed and with very promising results.

Dr. Susan O’Brien of MD Anderson Cancer Center Talks About New Drug Possibilities on the Horizon for Treating CLL
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