Every year, about 20,000 Americans are diagnosed with CLL. This promising new targeted treatment is spelling relief for relapsed patients.
Published May 9, 2019
There’s potentially good news for people suffering from relapsed chronic lymphocytic leukemia (CLL). A new study out from an Oregon hospital shows that combining an oral tablet called idelalisib (also known as Idela) with rituximab, which had traditionally been prescribed for use with chemotherapy, is both a safe and effective treatment for this chronic disease.
The randomized, double-blind phase III study, helmed by Dr. Jeff P. Sharman, MD, of Willamette Valley Cancer Institute and Research Center, was designed to be a five-year-long trial but was actually terminated early, “because of the superior efficacy of Idela plus rituximab (IDELA/R).” Which led to the drug’s FDA approval, according to the Journal of Clinical Oncology.
CLL is a slow-moving cancer that begins in the white blood cells, spreading out from the bone marrow and into the bloodstream, frequently advancing into organs such as the liver and spleen. The most common form of leukemia, it is most often found in elderly patients, with about 21,000 Americans being diagnosed each year—about 90 percent of them over the age of 50. Because the cancer grows so slowly, most people are symptom-free for years before diagnosis.
Symptoms of CLL can include fatigue, shortness of breath, anemia, enlarged lymph nodes, enlarged spleen or liver, and night sweats, among others, according to the Leukemia & Lymphoma Society.
Since there is still no cure for CLL, many treatments are palliative in nature, though chemotherapies, radiation, and surgical removal of the spleen are also used to keep it at bay. The first line of defense in patients with few symptoms and / or changes in their blood counts has been monitoring. Regular testing and exams can let your physician see how the disease is progressing— it is, again, a slow-growing cancer—though patients might find the inaction stressful. But the potential side effects of the (until now) treatments made this a wise choice.
This new option is a game changer, although it is only shown to work in patients who have relapsed; previously untreated patients are ineligible for the drug, because early studies showed increased death rates due to infection. Dr. Matthew Davids, of the Dana Farber Cancer Center told Survivornet that while the drug is very effective, there are side effects that patients should watch for. These include diarrhea, which can lead to colitis, liver irritation, which may cause elevated liver enzymes, and inflammation of the lungs.
Dr. Sharman’s study showed that “adding idelalisib to rituximab raised overall response rates from about 15.5 percent to 83.6 percent and median progression-free survival from 6.5 months to 19.4 months, resulting in significantly better clinical outcomes compared with those seen with rituximab alone” according to the Journal of Clinical Oncology.
Father, husband and football fan Michael Heer was just 38 years old when he was first diagnosed with CLL. With two toddlers and a baby on the way, the diagnosis was devastating, according to the Willamette Valley Cancer Institute in Oregon which treated him. But for the first year and a half, Heer had zero in the way of symptoms, and his doctor told him that as long as they monitored his situation carefully, he might not need treatment for years. Unfortunately, Heer started developing signs the disease was progressing within a year and a half. When it became clear that he was going to need treatment, his doctor prescribed chemotherapy.
When chemotherapy didn’t stop the progression of the disease, Heer enrolled in a clinical trial at Willamette Valley. The first trial was a flop, but lucky for him, Heer was then able to enroll in Dr. Sharman’s idelalisib study. The results were a resounding success. Heer told the hospital “I was told I would probably have five years to live. Here I am, 10 years later. I’ve received five extra years of life out of this, and the treatment landscape has completely changed. It’s no longer a death sentence, and I’m hopeful for what’s to come next.”
Experts talk to Survivornet about the significant new advances in treating patients who have recently been diagnosed with later-stage CLL.
For patients diagnosed with CLL, the go-to treatment option is usually some form of chemo-immunotherapy. But this is not an option for all patients.
Oral Medicine for Relapsed CLL: Venetoclax
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Oral Medicine for Relapsed CLL