Breaking News - Duke Center for Chronic Lymphocytic Leukemia
Updates in CLL/SLL
Breaking News
The way we treat Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma has changed dramatically over the past several years.  While chemotherapy is still the mainstay of therapy of CLL/SLL, other options exist.  These include FDA approved immunotherapy (rituximab, ofatumomab, and alemtuzumab) and new investigational targeted and immune therapies.  Some of the new therapies currently undergoing testing are described here.
Ibrutinib (PCI-32765):
  • A Bruton tyrosine kinase (BTK) inhibitor. 
  • BTK is a protein in the B-cell receptor signaling pathway. 
  • Interim results of treatment of 116 CLL/SLL patients with single agent ibrutinib demonstrated responses in 81% of elderly patients receiving initial therapy, 87% of patients with relapsed or refractory disease, and 79% of patients with "high risk" relapsed or refractory disease.

GS1101 (CAL-101):
  • A PI3K-delta inhibitor.
  • PI3K-delta is a specific form of PI3K that is part of the B-cell receptor signaling pathway. 
  • Initial results of a clinical trial of this single agent in CLL/SLL showed approximately 8 out of 10 CLL/SLL patients had some response, including patients with high risk features.  Further work has shown extremely high activity of GS1101 when it is combined with rituximab, bendamustine, or both.
Immune Approaches:
  • New approaches to attack CLL/SLL cells using the immune system are being developed. 
  • One of these is the use of chimeric antigen receptor (CAR) modified T-cells. 
  • The results of one study using these CAR T-cells to treat a small number of heavily pretreated and high risk CLL/SLL patients resulted in a dramatic response and elimination of detectable CLL/SLL cells.
We have hope that these and other new therapies will dramatically change the way we treat CLL/SLL.  
Many thanks to Sandip Patel, Hematology/Oncology fellow at Duke University, for assistance in compiling the information on this web page.

Duke University Cancer Center
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