NCCN Guidelines for Patients® | Chronic Lymphocytic Leukemia
30 NCCN Guidelines for Patients ® : Chronic Lymphocytic Leukemia, 2018 3 Cancer treatments Targeted therapy Targeted therapy Targeted therapy is a class of drugs that stops the action of molecules that help cancer cells grow. It is less likely to harm normal cells than chemotherapy. There are multiple targeted therapies that are used to treat CLL. They include monoclonal antibodies and kinase inhibitors. Monoclonal antibodies are man-made antibodies that attach to proteins on cancer cells. The monoclonal antibodies used to treat CLL attach to antigens. When antibodies are attached to antigens on a cell, the cell is marked to be destroyed by your immune system. Kinases are molecules that move chemicals, called phosphates, from one molecule to another. Kinase inhibitors stop the phosphates from being moved. Kinase inhibitors often block growth signals within cancer cells. This reduces the number of new cancer cells being made. Next, the targeted therapies for CLL are briefly described. Some side effects are listed. Ask your treatment team for a full list of common and rare side effects. In Part 4, information on who should receive these drugs is provided. Alemtuzumab Alemtuzumab is a monoclonal antibody that attaches to a molecule called CD52. CD52 is found on CLL cells, healthy B-cells and T-cells, as well as other cells. Alemtuzumab is used alone and sometimes with other medicines to treat CLL. Alemtuzumab is a liquid that will be slowly injected into your vein. It may take up to two hours to get the full dose. Alemtuzuamb can also be given as an injection under the skin. Alemtuzumab is often given three times a week for 12 weeks. Common side effects include an allergic reaction when receiving the medicine. Also, you may feel nausea, vomit, get diarrhea, and have trouble sleeping. Blood counts are often low when taking this medicine. Taking alemtuzumab will increase your chances of getting a cytomegalovirus or other infection. Ibrutinib Ibrutinib is a kinase inhibitor. It stops a kinase called BTK ( B ruton’s t yrosine k inase). This kinase is found inside of CLL cells and normal B-cells. Ibrutinib is usually taken without other cancer medicines to treat CLL. It is made in pill form and taken once a day around the same time. Your doctor will tell you how many pills you need for your dose. Common side effects of ibrutinib include diarrhea, tiredness, muscle and bone pain, bruising, nausea, upper respiratory tract infection, and rash. There may be a short-lived increase in lymphocytes when first taking ibrutinib. Serious but uncommon side effects include bleeding, severe infections, heart and kidney problems, and other cancers. Idelalisib Idelalisib is a kinase inhibitor. It stops a kinase called PI3K ( p hospho i nositide 3 - k inase delta). This kinase is found inside of CLL cells and normal B-cells. Idelalisib is used alone or sometimes with rituximab to treat CLL. It is made in pill form and is taken twice a day. Your doctor will tell you how many pills you need for your dose. Common side effects of idelalisib include diarrhea, fever, fatigue, nausea, cough, lung infection, belly pain, chills, and rash. White blood counts are often low when taking this medicine. However, there may be a short-lived increase in lymphocytes when first taking idelalisib.