Targeted Therapy

Scientists are learning more about the cell signals (the communication of information within the cell and between cells) that contribute to the growth and survival of CLL and SLL cells. Drugs are being developed to specifically block these signals and stop the growth and spread of CLL and SLL cells, while limiting damage to healthy cells.

There are many new targeted therapies undergoing investigation in clinical trials and some have recently been approved to treat CLL.

Many of these targeted therapies are available in pill form, making it possible for patients to take their medication at home.

Most targeted therapies affect the bone marrow so there is a risk of infection and bleeding.  Many patients experience fatigue and the drugs can cause nausea or bowel upset.  Some of these drugs can also cause peripheral neuropathy (see description under chemotherapy side effects).

Currently, the drugs ibrutinib, idelalisib and venetoclax are the only targeted therapies approved by Health Canada for the treatment of patients with CLL.

Ibrutinib (Imbruvica®)

Ibrutinib is a drug that attaches directly to a protein called Bruton's tyrosine kinase (BTK), which is very active in CLL cells. BTK sends signals in the cell to help it grow and survive. Ibrutinib blocks the signals from BTK, which helps stop or slow down the division and survival of CLL cells.

Ibrutinib comes in pills (tablets) that must be taken every day.

Ibrutinib has been approved by Health Canada for treatment of the following patients with CLL:

  1. Previously untreated CLL with 17p deletion.
  2. Previously untreated CLL and not considered appropriate for treatment with a fludarabine-based regimen.
  3. Those who have received at least one prior therapy and are not considered appropriate for treatment or re-treatment with a fludarabine-based regimen (ibrutinib alone or in combination with bendamustine and rituximab).

Ibrutinib is currently reimbursed by some public and private drug insurance programs in Canada. Janssen offers a patient support program for those being treated with ibrutinib and, in some cases, for those who need assitance to access ibrutinib. You can find out more here or you can email imbruvica@bioadvancemail.ca.

Find information on potential side effects here.

Idelalisib (Zydelig®)

Idelalisib is a drug that blocks the signals from a protein called phosphoinositide 3-kinase (PI3K)-delta. The main job of PI3K-delta is to send signals that help B cell grow, divide and survive. By blocking the signal from PI3K-delta, idelalisib helps stop or slow down the growth of CLL and SLL cells.

Idelalisib comes in pills (tablets) that must be taken every day.

Idelalisib has been approved by Health Canada for treatment of the following patients with CLL:

  1. In combination with rituximab for those who have received at least one prior treatment.

Idelalisib is currently reimbursed by some public and private drug insurance programs in Canada. For information about access to idelalisib, contact the Gilead Oncology Patient Support Program: 1-844-453-6777

Find information on potential side effects here.

Venetoclax (Venclexta®)

Venetoclax is a drug that attaches to a protein called b-cell lymphoma 2 (Bcl-2). Bcl-2 plays an important role in keeping cells alive by blocking the actions of proteins that cause cell death. By attaching to Bcl-2, venetoclax stops Bcl-2 from inhibiting cell death.

Venetoclax comes in pills (tablets) that must be taken every day.

Venetoclax has been approved by Health Canada for treatment of the following patients with CLL:

  1. Those with 17p deletion who have received at least one prior therapy.
  2. Those without 17p deletion who have received at least one prior therapy and for whom there are no other available treatment options.

Venetoclax is currently not reimbursed by public or private drug insurance programs in Canada. For assistance with access to venetoclax, call the Abbvie Care Program: 1-844-346-6626

 Find information on potential side effects here.