What to Know About Changes in CLL Care
- Dallas patients with chronic lymphocytic leukemia (CLL), a slow-growing type of blood cancer, are benefiting from major advances in treatment, with targeted therapies changing how the disease is approached.
- BTK inhibitors have become the standard of care when treatment is needed for CLL, replacing chemotherapy for many patients by targeting the biology of the disease while causing fewer side effects.
- “When we interrupt that signaling, we disrupt things that are vital for these cancer cells for growth, survival, and proliferation,” Dr. Yair Levy, a hematologist at Baylor University Medical Center, tells SurvivorNet of BTK inhibitors.
- New treatments such as pirtobrutinib are expanding options, particularly for those whose disease has become resistant to earlier BTK inhibitors.
- Combination therapies also continue to show promising results in clinical studies.
- Dallas remains at the forefront of a rapidly evolving era in CLL care, offering patients access to increasingly effective treatment strategies. Dr. Levy says today’s therapies are helping patients live longer and better lives.
At Baylor University Medical Center in Dallas, hematologist Dr. Yair Levy has witnessed the transformation firsthand.
Read MoreA New Era for CLL Care
When Dr. Levy began treating CLL, chemoimmunotherapy (which combines chemo with immunotherapy, which helps boost your body’s immune system to attack cancer cells) was considered the standard of care. While it worked well for some patients, many with high-risk genetic features experienced shorter responses.
“Unfortunately, it was not as effective as we’d like in a large subset of patients,” especially those with genetic markers associated with a poor prognosis, such as a 17p deletion or unmutated IGHV (Immunoglobulin Heavy Chain Variable region).
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But the development of targeted therapies such as BTK inhibitors (Bruton’s tyrosine kinase) and BCL-2 inhibitors, have changed the game. “They work independent of these risk factors,” Dr. Levy explains.
“The way that we explain BTK inhibitors to patients is we let them know that this is part of what’s called the B-cell receptor pathway,” he adds. “What they do is they interrupt B-cell receptor signaling. CLL is a cancer of B-cells. And when we interrupt that signaling, we disrupt things that are vital for these cancer cells for growth, survival, and proliferation.”
Targeted Therapies Have Become the Standard
It is important to note that many people with CLL can safely remain on a “watch-and-wait” plan for months or even years after diagnosis, treatment begins when the disease starts causing symptoms, progresses, or blood counts worsen. At that point, targeted therapies have become the standard of care.
These medications interfere with signals cancer cells need to survive.
They “inhibit a pathway that’s critical to the cancer cells and less critical to normal cells,” Dr. Levy explains. “When we interrupt that signaling, we disrupt things that are vital for these cancer cells for growth, survival, and proliferation.”
According to Dr. Levy, patients and physicians now have far more choices than ever before, and these treatments continue to progress and get better.
“We have a lot of options and these are very well tolerated and can give us very good disease control,” he notes.
New Treatments Expand Options
One of the newest therapies, pirtobrutinib (Jaypirca), offers hope for patients whose disease has stopped responding to earlier BTK inhibitors.
“With pirtobrutinib… we’ve seen that we can get most patients to respond… despite progression on the covalent [BTK inhibitors]. So it certainly gives us another lifeline for these patients at their highest unmet need,” Dr. Levy says.
How can pirtobrutinib (Jaypirca) fit in your treatment plan?
Researchers are also studying pirtobrutinib in combination with other targeted therapies, with early clinical trials showing deeper responses and longer periods before disease progression.
Better Quality of Life
Beyond extending survival, today’s treatments are also helping patients maintain their daily routines.
Unlike chemotherapy, BTK inhibitors specifically target CLL cells while sparing many healthy cells.
“They’re not cytotoxic chemotherapy,” Dr. Levy says. “They don’t just target rapidly dividing cells… Instead, what they do is they interrupt that B-cell receptor pathway.”
Many patients can remain on these medications for years.
“If you take a look at the average time someone is on a BTKI, it tends to be close to a decade,” he says.
While infections remain the most significant side effect, Dr. Levy says most other adverse events are manageable through supportive care or dose adjustments.
The Future of CLL Care
As Dallas-area patients gain access to an expanding number of clinical trials and innovative therapies, Dr. Levy believes the future of CLL care is brighter than ever.
He is especially encouraged by the development of BTK degraders (which remove the BTK protein instead of blocking it), CAR T-cell therapies (chimeric antigen receptor T-cells, a type of immunotherapy that involves modifying a patient’s own T cells so they can better recognize and attack cancer cells in the body), bispecific antibodies, and other next-generation treatments that may one day offer functional cures for even more patients.
“There is certainly a very bright future for CLL,” Dr. Levy notes.
Questions To Ask Your Doctor
- Based on my genetic testing and overall health, which treatment options are most appropriate for me?
- What are the benefits and possible side effects of targeted therapies, such as BTK inhibitors or BCL-2 inhibitors?
- If my CLL stops responding to treatment, what newer therapies might be available?
- What symptoms or changes should I report right away, and how often will I need follow-up visits and blood tests?
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