Chronic Lymphocytic Leukemia (CLL): Targeted Therapy
What is targeted therapy?
Targeted therapy is the use of medicines that take aim at parts of cancer cells that make them different from normal cells. They do this without affecting most normal, healthy cells. The medicines are different from standard chemotherapy medicines. And they have different side effects.
Types of targeted therapy for CLL
This is a kind of targeted therapy that uses antibodies made in a lab. The antibodies are like those your immune system makes naturally. They attach to leukemia cells and kill them or stop them from growing. Monoclonal antibodies are often used alone or with chemotherapy as part of the first treatment for CLL. They may also be used if other treatment sdon't work, or if the leukemia comes back. Monoclonal antibodies used to treat CLL include:
These medicines block proteins called kinases inside leukemia cells. The kinases normally help the cancer cells grow. Kinase inhibitors used to treat CLL include:
How targeted therapy is done
Monoclonal antibodies are given through a small, flexible tube that is put into a vein (IV), usually over several hours. They may be given in a healthcare provider's office, chemotherapy clinic, or in the outpatient department of a hospital. These medicines can sometimes cause allergic reactions while they are being given. This reaction may be serious in some people. You may get the monoclonal antibodies to lower the chance of an allergic reaction. You may get treatment from once a month to several times a week. In some cases, these medicines may be given along with chemotherapy.
Kinase inhibitors are taken as pills or capsules each day. Even though these medicines are taken as pills, they are strong medicines that can sometimes have serious side effects. It's very important to take these medicines exactly as your health cancer provider tells you.
Tell your healthcare provider about all other medicines you take. This includes over-the-counter medicines and supplements such as herbs and vitamins. Some medicines and supplements can change the way targeted therapy medicines work.
During treatment, you’ll have blood tests. These are done to check for a decrease in your levels of white or red blood cells or platelets. These tests will happen more often at the start of treatment.
Possible side effects of monoclonal antibodies
The main side effects of monoclonal antibody therapy are fever and chills during the treatment. The fever may be high. It usually goes down or away when the treatment is slowed or stopped. Some people may have rashes. In rare cases, people may have more serious problems. These include trouble breathing and low blood pressure. These problems are most common the first time a person gets the medicine.
You may also get an infection more easily. This is because the antibodies can damage your immune system cells. This problem can sometimes be serious with the medicine alemtuzumab. It can cause very low white blood cell counts. You may get a special treatment ahead of time to reduce the risk of these side effects.
Less common serious side effects can include:
Blockage in the intestines
Increased risk of bleeding from low levels of blood platelets
The hepatitis virus becoming active again in the body. This is true only if it is already in your body from an old infection.
In rare cases, these medicines can cause tumor lysis syndrome. This is when the medicine kills the cancer cells so fast that the body can’t get rid of the waste products of the dead cells fast enough. Extra IV fluids and certain medicines can be used to help keep this from happening.
Possible side effects of kinase inhibitors
Side effects of kinase inhibitors depend on the medicine. They can include:
Feeling tired (fatigue)
Lower blood cell counts, which can increase a person's risk of infections, bleeding, and bruising
Less often, more serious side effects can occur. These include:
Fluid buildup around the heart or lungs. This can cause trouble breathing.
Working with your healthcare provider
It's important to know which medicines you're taking. Write down your medicines. Ask your healthcare team how they work, and what side effects they might have.
Talk with your healthcare providers about what side effects to watch out for, and when you should call your healthcare team. Know what number to call with questions, even on evenings and weekends.
It may be helpful to keep a diary of your side effects. Write down any physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your medical team to make a plan to manage your side effects.
June 19, 2018
LoCicero, Richard, MD,Stump-Sutliff, Kim, RN, MSN, AOCNS