Targeted therapy for chronic lymphocytic leukaemia (CLL)

Targeted therapy uses drugs to find and attack cancer cells. There are many different types of targeted therapy. Each type targets something in or around the cancer cell that is helping it grow and survive. Because these drugs only target the cancer cells, they have less effect on healthy cells than other treatments.

BCR inhibitors are a type of targeted therapy used to treat CLL. They work by targeting proteins on the surface of cancer cells. The B-cell receptor is a protein found on the surface of CLL cells. It controls how CLL cells grow. If the B-cell receptor is switched off, the CLL cells die.

BCR inhibitors target the B-cell receptors to stop the cancer growing and dividing.

The drugs that can be used for CLL are:

• ibrutinib (Imbruvica^®)
• acalabrutinib.

You take these as tablets or capsules every day. You usually continue taking them for as long as they are working.

Monoclonal antibodies treat CLL by targeting proteins on white blood cells called B-lymphocytes (B-cells). This makes the B-cells die.

Monoclonal antibodies are usually given with chemotherapy or with other types of targeted therapy. They are usually given as a drip into a vein.

Monoclonal antibody treatments used for CLL include:

• rituximab
• obinutuzumab (Gazyvaro^®)
• ofatumumab (Arzerra^®).
• alemtuzumab – this is only sometimes used to treat CLL. 

How monoclonal antibodies are given

Monoclonal antibodies are usually given into a vein as a drip (infusion). You can have them as an outpatient. You may be asked to stay in hospital overnight for your first treatment.

You may have a reaction during the infusion. A reaction is more likely with the first infusion, so it is given slowly over a few hours. Reactions are usually milder after the first infusion. You are also given medicines before each infusion to help prevent or reduce any reaction.

Symptoms of a reaction can include:

• a high temperature
• shivering and shaking
• a rash
• low blood pressure
• feeling sick (nausea).

If you have any of these symptoms or feel unwell during or soon after an infusion, tell your nurse or doctor straight away.

Alemtuzumab can also be given as an injection under the skin (subcutaneously). In this case, it is less likely to cause a reaction. But it may cause some redness, swelling or soreness around the area where it is injected. This usually goes away after 1 to 2 weeks.

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

• use plain English
• explain medical words
• use short sentences
• use illustrations to explain text
• structure the information clearly
• make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.