Targeted therapies in CLL: one drug or a combination?

This study reviewed research on the effectiveness of single and combined therapies for chronic lymphocytic leukemia (CLL). Researchers found that combining drugs may be more effective in the treatment of CLL.

Chronic lymphocytic leukemia is a blood cancer of the bone marrow and immune system. It is often treated with medication that targets abnormal genes or certain proteins on cancer cells. Treatment sometimes involves one drug, or more than one. It is important to research the effectiveness of using one drug or more in the treatment of CLL.

A variety of studies of one drug or a combination of drugs were reviewed in this paper.

Obinutuzumab (Gazyva) was studied in a trial of patients with CLL. It had an overall response rate of 62% in a phase 1 study.

Ibrutinib (Imbruvica) was studied in a trial of 85 patients with CLL. The overall response rate was 71%. Studies also showed that ibrutinib was significantly more effective than ofatumumab (Arzerra) in CLL.

Acalabrutinib (Calquence) was used in a study of 134 patients with CLL. Overall response rate after 20 months was 93%. Side effects included low white blood cells (11%) and pneumonia (10%).

Idelalisib (Zydelig) is a different type of drug used to target the immune system. A study combined it with rituximab (Rituxan) and compared it to rituximab alone in 220 patients. Overall survival was 81% in the idelalisib group compared to 13% in the rituximab alone group.

In younger patients, ibrutinib has been combined with chemotherapy for CLL patients. One small study showed a response rate of 83%. Another study of 18 patients included using ibrutinib with fludarabine, cyclophosphamide, and obinutuzumab. 14 (78%) patients had a good response after 3 months.

The study concluded that using a combination of different drugs may be more effective in the treatment of CLL.

This review contained a number of small studies. Larger research of newer combinations may be useful.