Targeted therapy for CLL

Targeted therapies are drugs that recognise certain proteins on the surface of cells. In CLL, they are designed to block the growth and destroy the abnormal lymphocytes.

There are different types of targeted therapies. They all act in different ways and have different side effects. They are often used in combination with chemotherapy. The ones most commonly used to treat CLL are called monoclonal antibodies.

Monoclonal antibodies

The monoclonal antibodies most commonly used to treat CLL are:

  • rituximab (Mabthera®)
  • alemtuzumab (Campath®).

Rituximab is often given with the chemotherapy drugs fludarabine and cyclophosphamide, (called FCR) and also with bendamustine.

Alemtuzumab may be given with chemotherapy or on its own. It may be used if your leukaemia has come back after chemotherapy treatment.

You may be able to have targeted therapy treatment as an outpatient or you may be asked to stay in hospital overnight. Rituximab and alemtuzumab can be given by a drip (intravenous infusion).

Most people don’t have many side effects. But some people may have a reaction during, or just after, the first infusion. You’ll be given your first infusion very slowly to reduce the chance of this happening. You’ll also be given medicines to help reduce any reaction you get. Reactions are usually milder with a second infusion and any infusions after that.

Symptoms showing a reaction can include:

  • a high temperature
  • shakes
  • a rash
  • low blood pressure
  • feeling sick (nausea).

Alemtuzumab can also be given as an injection under the skin (subcutaneously). In this case, it’s less likely to cause a reaction. You may notice some redness, swelling or soreness in the area where you had the injection, but this usually goes away after a week or two.

Targeted therapy treatments can lower your resistance to infection. You’ll probably be given antibiotics during treatment and for some time afterwards to prevent an infection.

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos

Newer monoclonal antibodies

There are also two newer monoclonal antibody drugs, ofatumumab and obinutuzumab, that may sometimes be used to treat CLL.

Ofatumumab or obinutuzumab can be used as a first treatment option for those who are unable to have fludarabine or bendamustine. 

Ofatumumab or obinutuzumab can be given with the chemotherapy drug chlorambucil. Your haematologist can tell you whether either of these treatments might be helpful in your situation.

Both ofatumumab and obinutuzumab are given through a drip into a vein (intravenously). They can sometimes cause an allergic reaction while they are being given. You will be given medicines to reduce the chance of this happening and be closely monitored during your treatment. You can ask your haematologist to explain more about this.

Other new targeted therapies

B-cell receptor inhibitors

Ibrutinib and Idelalisib are B-cell receptor inhibitors. They target the receptors (proteins) on the surface of the cells and stop the cancer growing and dividing.

These drugs might be used when other treatments are no longer working. They are taken by mouth as tablets. Your haematologist will explain whether these treatments might help you.

Ibrutinib and Idelalisib may only be available in some situations. Your haematologist can tell you if they are suitable for you. If a drug is not available on the NHS, there may be different ways you can access it. Your haematologist can give you advice.

There are other types of targeted drugs being researched and tested in clinical trials.

Back to Targeted (biological) therapies explained

Cancer growth inhibitors

Cancer growth inhibitors block certain chemical signals within cells, which slows down or stops the growth of the cancer.

Monoclonal antibodies

Monoclonal antibodies can attach themselves to cancer cells to prevent them from growing.