Chemotherapy

Chemotherapy is a type of treatment that includes a drug or combination of drugs to kill cancer cells. A combination of drugs is often prescribed to improve the chances for success as each drug kills the cancer in a different way.  If chemotherapy is given in combination with antibody therapy it is called chemoimmunotherapy (CIT).

How chemotherapy works

Chemotherapy is a systemic therapy, which means it affects the whole body. Chemotherapy targets and kills cells that grow and divide quickly, such as cancer cells. Because of how they work, chemotherapy drugs can also have the same effect on normal cells that divide quickly, like hair, nails, and the cells in your mouth and digestive tract. This is why chemotherapy can cause side effects including hair loss, diarrhea, nausea and vomiting.

How chemotherapy is given

Each dose of chemotherapy kills only a percentage of cancer cells. For this reason, chemotherapy is often given in multiple doses in order to destroy as many cancer cells as possible. 

Chemotherapy treatment is usually followed by a period of rest and recovery. Together, each period of treatment and recovery is called a chemotherapy cycle. Chemotherapy drugs may be given once per cycle or on multiple days per cycle, depending on your treatment plan. The full course of chemotherapy (the total number of cycles) may take several months.

A typical treatment session will involve having blood tests and a visit with your oncologist or nurse, followed by your chemotherapy.

Many chemotherapy drugs are given by needle directly into a vein (intravenous or IV infusion). Some drugs are given by mouth as capsules or pills.

If you are going to receive intravenous drugs, your doctor might recommend having a central venous catheter inserted.  This is usually only required for patients with small or fragile veins that make it difficult to insert a standard intravenous needle into a vein in the arm.

A venous catheter (a small, flexible plastic tube) is a device that is put into a vein to make it easier to give medication.  There are different types but each device works in the same way. The one chosen for you will depend on the normal practices at your hospital.

Standard chemotherapy drugs that doctors use to treat CLL, alone or in combination include:

  • Fludarabine (Fludara®)
  • Cyclophosphamide (Cytoxan®)
  • Bendamustine (Treanda®)
  • Chlorambucil (Leukeran®)
  • Doxorubicin (Adriamycin®)
  • Vincristine (Oncovin®)

Common chemotherapy regimens for CLL and SLL

Please note, some chemotherapy regimens also involve antibody therapy, like Rituximab or Obinutuzumab.  You can find out more bout antibody therapy here.

Fludarabine, Cyclophosphamide, and Rituximab (FCR)

FCR is usually recommended as the first treatment (also called induction or first-line treatment) for younger (less than 65-70 years-old), fit patients and results in long-lasting disease remissions in many patients. FCR combination was the first therapy in CLL shown to significantly prolong overall survival (OS). Fludarabine and cyclophosphamide can be given as infusions into a vein or as tablets (pills), while rituximab is always given as an intravenous infusion. Older patients, particularly those who are frail or have poor kidney function, are unlikely to tolerate FCR well.

Chlorambucil and Obinutuzumab

In older patients with underlying health conditions (such as heart disease or poor kidney function), the combination of chlorambucil and obinutuzumab has proven to be a very effective therapy for CLL. When compared with chlorambucil alone, or the combination of chlorambucil and rituximab, chlorambucil and obinutuzumab proved to be the most effective at prolonging progression-free survival.

Bendamustine and Rituximab (BR)

BR can be used to treat older, fit patients if FCR is considered inappropriate. The side effects of bendamustine are generally milder than those commonly experienced with fludarabine. In a large clinical study, patients 65 years and older experienced fewer toxic effects with BR than with FCR, and there was no significant difference in progression-free survival between the two groups.