Chronic Lymphocytic Leukemia (CLL): Targeted Therapy
What is targeted therapy?
Targeted therapy is the use of medicines that target parts of cancer cells that make them unlike normal cells. They do this without affecting most normal, healthy cells. Targeted medicines for non-Hodgkin lymphoma work on genes and proteins in lymphoma cells. The medicines are different from standard chemotherapy medicines. They may work when chemotherapy medicines don’t. And they have different side effects.
Types of targeted therapy for CLL
Monoclonal antibodies. 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 their growth. 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 doesn't work, or if the leukemia comes back. Monoclonal antibodies used to treat CLL include:
Kinase inhibitors. These are newer medicines that block proteins called kinases inside leukemia cells. The kinases normally help the cancer cells grow. Kinase inhibitors are used after at least one other treatment has been tried for CLL. These medicines are also being studied for use in treating CLL earlier. Kinase inhibitors used to treat CLL include:
How targeted therapy is done
Monoclonal antibodies are given into a vein (IV), usually over several hours. They may be given in a doctor's office, chemotherapy clinic, or in the outpatient department of a hospital. These medicines can sometimes cause allergic reactions while they are being given, which in some people may be serious. You may get medicines before the infusion 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 directed by your health cancer provider.
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
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.
Possible side effects of kinase inhibitors
Side effects of kinase inhibitors depend on the medicine. They can include:
Swelling in the feet or hands
Lower blood cell counts, which can increase a person's risk of infections, bleeding, and bruising
Less often, more serious side effects can occur.
Working with your healthcare provider
It's important to know which medicines you're taking. Write your medicines down, 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 to call them. Make sure you 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 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.
March 21, 2017
Alteri, Rick, MD,Cunningham, Louise, RN